Provider Demographics
NPI:1114010055
Name:CHOICES COUNSELING & RESOURCE CENTER PA
Entity Type:Organization
Organization Name:CHOICES COUNSELING & RESOURCE CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:H
Authorized Official - Last Name:REFVEM
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:336-786-2053
Mailing Address - Street 1:201 N MAIN ST
Mailing Address - Street 2:STE 300
Mailing Address - City:MOUNT AIRY
Mailing Address - State:NC
Mailing Address - Zip Code:27030-3867
Mailing Address - Country:US
Mailing Address - Phone:336-786-2053
Mailing Address - Fax:336-786-2198
Practice Address - Street 1:201 N MAIN ST
Practice Address - Street 2:STE 300
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-3867
Practice Address - Country:US
Practice Address - Phone:336-786-2053
Practice Address - Fax:336-786-2198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3844101YP2500X
NC0100005M101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Not Answered101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC142UJOtherBCBS NC