MEDICARE: BANNER CONSULTING

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	3565	NC

General Provider Information

NPI Number	:	1194124412
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BANNER CONSULTING

Provider Business Mailing Address
First Line	:	2525 RAEFORD RD
Second Line	:	SUITE B
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28305-5091
Country	:	US
Telephone Number	:	910-309-1574
Fax Number	:

Provider Business Practice Location Address
First Line	:	2525 RAEFORD RD
Second Line	:	SUITE B
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28305-5091
Country	:	US
Telephone Number	:	910-309-1574
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	JERRY DEAN POWELL
Credential	:	DMIN
Telephone Number	:	910-309-1574

Provider Enumeration Date	:	08/22/2014
Last Update Date	:	08/22/2014

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Directions to “BANNER CONSULTING ” Practice Location

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