Provider Demographics
NPI:1013231935
Name:THERAPEUTIC INTERACTIONS COUNSELING SERVICES, PLLC
Entity Type:Organization
Organization Name:THERAPEUTIC INTERACTIONS COUNSELING SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:PAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-379-1102
Mailing Address - Street 1:P O BOX 134
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590-9748
Mailing Address - Country:US
Mailing Address - Phone:252-689-8671
Mailing Address - Fax:252-793-2158
Practice Address - Street 1:323 CLIFTON STREET
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5053
Practice Address - Country:US
Practice Address - Phone:252-689-8671
Practice Address - Fax:252-793-2158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-22
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC005182251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6106231Medicaid
NC1144385642Medicaid