MEDICARE: HEALING HARBOR COUNSELING, 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

General Provider Information

NPI Number	:	1831824309
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALING HARBOR COUNSELING, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 2598
Second Line	:
City	:	SURF CITY
State	:	NC
Zip	:	28445-0028
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13500 NC HIGHWAY 50 STE 213
Second Line	:
City	:	SURF CITY
State	:	NC
Zip	:	28445-7934
Country	:	US
Telephone Number	:	910-375-1565
Fax Number	:

Authorized Official
Title or Position	:	COUNSELOR
Name	:	MEGAN KOVACH
Credential	:	LCMHCA
Telephone Number	:	252-455-2239

Provider Enumeration Date	:	07/19/2022
Last Update Date	:	07/19/2022

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