MEDICARE: ENLIGHTENED COUNSELING AND WELLNESS 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	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1427770684
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENLIGHTENED COUNSELING AND WELLNESS PLLC

Provider Business Mailing Address
First Line	:	701 SPENCER LN
Second Line	:
City	:	KANNAPOLIS
State	:	NC
Zip	:	28081-0012
Country	:	US
Telephone Number	:	704-224-3077
Fax Number	:

Provider Business Practice Location Address
First Line	:	705 S MAIN ST STE 7
Second Line	:
City	:	KANNAPOLIS
State	:	NC
Zip	:	28081-4915
Country	:	US
Telephone Number	:	704-269-8773
Fax Number	:

Authorized Official
Title or Position	:	MEMBER/ ORGANIZER
Name	:	MRS. HALBREONDA MCNEILL HOLLOWAY
Credential	:	LCSW
Telephone Number	:	704-224-3077

Provider Enumeration Date	:	09/14/2022
Last Update Date	:	07/19/2023

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