=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952002966
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EQUIP COUNSELING & CONSULTING, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/15/2023
-----------------------------------------------------
Last Update Date | 12/18/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 810 CANNONADE DR
-----------------------------------------------------
City | WHITSETT
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27377-8010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-303-8854
-----------------------------------------------------
Fax | 336-203-3450
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7 CORPORATE CENTER CT STE B
-----------------------------------------------------
City | GREENSBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27408-3839
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-303-8854
-----------------------------------------------------
Fax | 336-203-3450
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/OWNER
-----------------------------------------------------
Name | TENISHA NICOLE MCLEAN
-----------------------------------------------------
Credential | LCMHCS
-----------------------------------------------------
Telephone | 336-303-8854
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------