MEDICARE: COLLABORATIVE CARE 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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1417807132
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLLABORATIVE CARE COUNSELING, PLLC

Provider Business Mailing Address
First Line	:	140 PRESTON EXECUTIVE DR STE 100A
Second Line	:
City	:	CARY
State	:	NC
Zip	:	27513-8488
Country	:	US
Telephone Number	:	919-386-3531
Fax Number	:	919-439-0415

Provider Business Practice Location Address
First Line	:	140 PRESTON EXECUTIVE DR STE 100A
Second Line	:
City	:	CARY
State	:	NC
Zip	:	27513-8488
Country	:	US
Telephone Number	:	919-386-3531
Fax Number	:	919-439-0415

Authorized Official
Title or Position	:	OWNER
Name	:	STACY COHEN
Credential	:
Telephone Number	:	919-328-0013

Provider Enumeration Date	:	02/02/2026
Last Update Date	:	02/02/2026

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