MEDICARE: SILVER OAKS COUNSELING, PLLC

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1124726088
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SILVER OAKS COUNSELING, PLLC

Provider Business Mailing Address
First Line	:	2329 GLASCOCK ST
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27610-1601
Country	:	US
Telephone Number	:	252-217-9335
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 WAKE FOREST RD STE 100
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27604-1354
Country	:	US
Telephone Number	:	252-217-9335
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	AMANDA JONES STANFORTH
Credential	:	LCSW
Telephone Number	:	252-217-9335

Provider Enumeration Date	:	02/21/2023
Last Update Date	:	02/21/2023

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