MEDICARE: SELF-TALK COUNSELING & CONSULTING, 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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1144724980
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SELF-TALK COUNSELING & CONSULTING, PLLC

Provider Business Mailing Address
First Line	:	3126 MILTON RD STE 234
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28215-3782
Country	:	US
Telephone Number	:	980-285-3689
Fax Number	:	866-313-6091

Provider Business Practice Location Address
First Line	:	3126 MILTON RD STE 234
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28215-3782
Country	:	US
Telephone Number	:	980-285-2689
Fax Number	:	866-313-6091

Authorized Official
Title or Position	:	OWNER
Name	:	KAREEM C PURANDA
Credential	:	LCMHCS, LCAS, NCC
Telephone Number	:	980-234-5464

Provider Enumeration Date	:	03/19/2018
Last Update Date	:	09/03/2024

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