Provider Demographics
NPI:1104186527
Name:PIEDMONT COUNSELING & CONSULTING PLLC
Entity Type:Organization
Organization Name:PIEDMONT COUNSELING & CONSULTING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:D
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:980-285-7236
Mailing Address - Street 1:1562 UNION RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-2210
Mailing Address - Country:US
Mailing Address - Phone:980-285-7236
Mailing Address - Fax:704-903-6043
Practice Address - Street 1:1562 UNION RD
Practice Address - Street 2:SUITE B
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-2210
Practice Address - Country:US
Practice Address - Phone:980-285-7236
Practice Address - Fax:704-903-6043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-18
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0066371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty