MEDICARE: PROGRESS AND PEACE 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	1041C0700X	Clinical Social Worker	C007632	NC

General Provider Information

NPI Number	:	1891197562
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROGRESS AND PEACE COUNSELING SERVICES, PLLC

Provider Business Mailing Address
First Line	:	8045 CORPORATE CENTER DR
Second Line	:	SUITE 200
City	:	CHARLOTTE
State	:	NC
Zip	:	28226-4555
Country	:	US
Telephone Number	:	980-272-8213
Fax Number	:	980-238-2151

Provider Business Practice Location Address
First Line	:	8045 CORPORATE CENTER DR
Second Line	:	SUITE 200
City	:	CHARLOTTE
State	:	NC
Zip	:	28226-4555
Country	:	US
Telephone Number	:	980-272-8213
Fax Number	:	980-238-2151

Authorized Official
Title or Position	:	OWNER
Name	:	KELLY HOLLAND
Credential	:
Telephone Number	:	980-272-8213

Provider Enumeration Date	:	09/24/2014
Last Update Date	:	02/28/2015

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