MEDICARE: THE COUNSELING COLLECTIVE, 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	:	1851863609
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE COUNSELING COLLECTIVE, PLLC

Provider Business Mailing Address
First Line	:	1744 HERITAGE CENTER DR STE 201
Second Line	:
City	:	WAKE FOREST
State	:	NC
Zip	:	27587-9853
Country	:	US
Telephone Number	:	984-235-7596
Fax Number	:	984-235-7054

Provider Business Practice Location Address
First Line	:	1744 HERITAGE CENTER DR STE 201
Second Line	:
City	:	WAKE FOREST
State	:	NC
Zip	:	27587-9853
Country	:	US
Telephone Number	:	984-235-7596
Fax Number	:	984-235-7054

Authorized Official
Title or Position	:	OWNER/DIRECTOR
Name	:	KRISTA RENEE ETCHISON
Credential	:
Telephone Number	:	984-235-7596

Provider Enumeration Date	:	12/18/2018
Last Update Date	:	01/15/2026

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