MEDICARE: PARADIGM COUNSELING NC

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	5364	NC
2	101Y00000X	Counselor
3	101YP2500X	Professional Counselor
4	104100000X	Social Worker
5	1041C0700X	Clinical Social Worker	C006764	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11864332	OTHER	OH	CAQH

General Provider Information

NPI Number	:	1518121110
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARADIGM COUNSELING NC

Provider Business Mailing Address
First Line	:	7038 LANDINGHAM DR
Second Line	:
City	:	WILLOW SPRING
State	:	NC
Zip	:	27592-8620
Country	:	US
Telephone Number	:	330-671-2290
Fax Number	:	919-552-9918

Provider Business Practice Location Address
First Line	:	374 RALEIGH ST
Second Line	:
City	:	HOLLY SPRINGS
State	:	NC
Zip	:	27540-9047
Country	:	US
Telephone Number	:	919-601-9222
Fax Number	:	919-552-9918

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. RACHEL ANN LEAHY
Credential	:
Telephone Number	:	330-671-2290

Provider Enumeration Date	:	07/12/2008
Last Update Date	:	01/06/2014

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Directions to “PARADIGM COUNSELING NC ” Practice Location

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