MEDICARE: GINKGO SEEDS COUNSELING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1073330783
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GINKGO SEEDS COUNSELING

Provider Business Mailing Address
First Line	:	609 PINER RD # 2024
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28409-4201
Country	:	US
Telephone Number	:	910-518-8695
Fax Number	:

Provider Business Practice Location Address
First Line	:	609 PINER RD # 2024
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28409-4201
Country	:	US
Telephone Number	:	910-518-8695
Fax Number	:

Authorized Official
Title or Position	:	OWNER/THERAPIST
Name	:	HALEY MEYER
Credential	:
Telephone Number	:	910-518-8695

Provider Enumeration Date	:	09/24/2024
Last Update Date	:	09/24/2024

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