MEDICARE: WHISPERING WILLOWS COUNSELING SERVICES, 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	101Y00000X	Counselor
2	101YA0400X	Addiction (Substance Use Disorder) Counselor
3	101YM0800X	Mental Health Counselor
4	1041C0700X	Clinical Social Worker
5	101YP2500X	Professional Counselor	7694	NC

General Provider Information

NPI Number	:	1639621360
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHISPERING WILLOWS COUNSELING SERVICES, PLLC

Provider Business Mailing Address
First Line	:	403 PARKWAY
Second Line	:	SUITE G
City	:	GREENSBORO
State	:	NC
Zip	:	27401-1652
Country	:	US
Telephone Number	:	336-265-8420
Fax Number	:	844-273-3668

Provider Business Practice Location Address
First Line	:	403 PARKWAY
Second Line	:	SUITE G
City	:	GREENSBORO
State	:	NC
Zip	:	27401-1652
Country	:	US
Telephone Number	:	336-265-8420
Fax Number	:	844-273-3668

Authorized Official
Title or Position	:	CEO
Name	:	NIKKI CALDWELL
Credential	:	LPC
Telephone Number	:	336-327-6118

Provider Enumeration Date	:	10/28/2016
Last Update Date	:	10/28/2016

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