Provider Demographics
NPI:1114124401
Name:ANCHOR PSYCHOLOGICAL & COUNSELING SERVICES PLLC
Entity Type:Organization
Organization Name:ANCHOR PSYCHOLOGICAL & COUNSELING SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:M
Authorized Official - Last Name:GODIN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC LPA
Authorized Official - Phone:910-270-9995
Mailing Address - Street 1:16581 US HWY 17 N
Mailing Address - Street 2:SUITE 600
Mailing Address - City:HAMPSTEAD
Mailing Address - State:NC
Mailing Address - Zip Code:28443-7451
Mailing Address - Country:US
Mailing Address - Phone:910-270-9995
Mailing Address - Fax:910-270-9905
Practice Address - Street 1:16581 US HWY 17 N
Practice Address - Street 2:SUITE 600
Practice Address - City:HAMPSTEAD
Practice Address - State:NC
Practice Address - Zip Code:28443-7451
Practice Address - Country:US
Practice Address - Phone:910-270-9995
Practice Address - Fax:910-270-9905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-29
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4801101YM0800X
NC2335103TB0200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6006154Medicaid
NC6006154Medicaid