MEDICARE: SALEM 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	PC15349	NC

General Provider Information

NPI Number	:	1538641485
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SALEM COUNSELING & CONSULTING, PLLC

Provider Business Mailing Address
First Line	:	469 SHADY GROVE CT
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-5540
Country	:	US
Telephone Number	:	336-408-0009
Fax Number	:

Provider Business Practice Location Address
First Line	:	469 SHADY GROVE CT
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-5540
Country	:	US
Telephone Number	:	336-408-0009
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MICHELLE LEFEAVERS
Credential	:	LCMHC, LCAS
Telephone Number	:	336-408-0009

Provider Enumeration Date	:	09/06/2018
Last Update Date	:	04/18/2022

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