MEDICARE: CLINICAL COUNSELING AND CONSULTING 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	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YM0800X	Mental Health Counselor
3	101YP2500X	Professional Counselor
4	103T00000X	Psychologist
5	1041C0700X	Clinical Social Worker
6	251S00000X	Community/Behavioral Health Agency	C010223	NC
7	251S00000X	Community/Behavioral Health Agency	LCASA-21289	NC
8	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
9	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942744792
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLINICAL COUNSELING AND CONSULTING SERVICES, PLLC

Provider Business Mailing Address
First Line	:	2539 MCARTHUR LANDING CIR APT 102
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28311-9019
Country	:	US
Telephone Number	:	910-489-9036
Fax Number	:

Provider Business Practice Location Address
First Line	:	2931 BREEZEWOOD AVE STE 200
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28303-5281
Country	:	US
Telephone Number	:	910-748-0833
Fax Number	:

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	ELIZABETH CALDWELL
Credential	:	LCSW,LCAS
Telephone Number	:	910-489-9036

Provider Enumeration Date	:	12/13/2016
Last Update Date	:	08/18/2025

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