Provider Demographics
NPI:1073957775
Name:ECLECTIC THERAPEUTIC CONNECTIONS, PLLC
Entity Type:Organization
Organization Name:ECLECTIC THERAPEUTIC CONNECTIONS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ PSYCHOTHERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:TANIELLE
Authorized Official - Middle Name:LOVEVET
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, NCC
Authorized Official - Phone:919-637-4089
Mailing Address - Street 1:3605 TEMPIA CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-4291
Mailing Address - Country:US
Mailing Address - Phone:919-637-4089
Mailing Address - Fax:888-462-2058
Practice Address - Street 1:8601 SIX FORKS RD STE 400
Practice Address - Street 2:FORUM I
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-2965
Practice Address - Country:US
Practice Address - Phone:919-637-4089
Practice Address - Fax:888-462-2058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-24
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1298943251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health