MEDICARE: COUNTERSTEP COUNSELING AND CONSULTING, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	101YA0400X	Addiction (Substance Use Disorder) Counselor
3	101YM0800X	Mental Health Counselor
4	225C00000X	Rehabilitation Counselor
5	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1629612981
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNTERSTEP COUNSELING AND CONSULTING, PLLC

Provider Business Mailing Address
First Line	:	13534 PLAZA ROAD EXT STE 114
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28215-8921
Country	:	US
Telephone Number	:	704-299-5286
Fax Number	:

Provider Business Practice Location Address
First Line	:	13534 PLAZA ROAD EXT STE 114
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28215-8921
Country	:	US
Telephone Number	:	704-299-5286
Fax Number	:	704-299-5286

Authorized Official
Title or Position	:	DIRECTOR/OWNER
Name	:	MONIQUE PLEASANT
Credential	:
Telephone Number	:	704-299-5286

Provider Enumeration Date	:	10/30/2019
Last Update Date	:	11/06/2019

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