Provider Demographics
NPI:1073796272
Name:CONNOLLY COUNSELING, INC.
Entity Type:Organization
Organization Name:CONNOLLY COUNSELING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER (CEO)
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:J
Authorized Official - Last Name:CONNOLLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-260-0417
Mailing Address - Street 1:PO BOX 55
Mailing Address - Street 2:
Mailing Address - City:KENANSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28349-0055
Mailing Address - Country:US
Mailing Address - Phone:910-275-0010
Mailing Address - Fax:910-275-0013
Practice Address - Street 1:109 FAYETTEVILLE ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NC
Practice Address - Zip Code:28328-3901
Practice Address - Country:US
Practice Address - Phone:910-596-2020
Practice Address - Fax:910-275-0013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-11
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-082-063251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health