MEDICARE: COUNSELING PROFESSIONALS 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	101YM0800X	Mental Health Counselor	9420	NC
2	101YM0800X	Mental Health Counselor
3	1041C0700X	Clinical Social Worker
4	106H00000X	Marriage & Family Therapist
5	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1740634773
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNSELING PROFESSIONALS PLLC

Provider Business Mailing Address
First Line	:	7406 CHAPEL HILL RD
Second Line	:	SUITE J
City	:	RALEIGH
State	:	NC
Zip	:	27607-5039
Country	:	US
Telephone Number	:	919-819-6082
Fax Number	:	919-573-0438

Provider Business Practice Location Address
First Line	:	7406 CHAPEL HILL RD
Second Line	:	SUITE J
City	:	RALEIGH
State	:	NC
Zip	:	27607-5039
Country	:	US
Telephone Number	:	919-819-6082
Fax Number	:	919-573-0438

Authorized Official
Title or Position	:	OWNER
Name	:	MR. CHRISTOPHER JASON LEACH
Credential	:	MS NCC LCMHC
Telephone Number	:	919-819-6082

Provider Enumeration Date	:	04/15/2016
Last Update Date	:	10/06/2023

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