Provider Demographics
NPI:1083469266
Name:MATTERS OF THE HEART AND MIND COUNSELING AND CONSULTING, PLLC
Entity Type:Organization
Organization Name:MATTERS OF THE HEART AND MIND COUNSELING AND CONSULTING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZER/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHANTE'
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:704-930-8563
Mailing Address - Street 1:732 MABLE SPAULDING RD
Mailing Address - Street 2:
Mailing Address - City:WHITEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28472-7346
Mailing Address - Country:US
Mailing Address - Phone:704-930-8563
Mailing Address - Fax:
Practice Address - Street 1:732 MABLE SPAULDING RD
Practice Address - Street 2:
Practice Address - City:WHITEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28472-7346
Practice Address - Country:US
Practice Address - Phone:704-930-8563
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-20
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1891141354OtherNPS