Provider Demographics
NPI:1114185733
Name:INTERFACE COUNSELING & COUSULTING INC
Entity Type:Organization
Organization Name:INTERFACE COUNSELING & COUSULTING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:GLENDA
Authorized Official - Middle Name:C
Authorized Official - Last Name:SAWYER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:910-389-5371
Mailing Address - Street 1:1 SUNSET ST
Mailing Address - Street 2:
Mailing Address - City:WEAVERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28787-9462
Mailing Address - Country:US
Mailing Address - Phone:910-389-5371
Mailing Address - Fax:
Practice Address - Street 1:1 SUNSET ST
Practice Address - Street 2:
Practice Address - City:WEAVERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28787-9462
Practice Address - Country:US
Practice Address - Phone:910-389-5371
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-30
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0018031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6002868Medicaid
NC327766OtherMHN
NC74652OtherBLUE CROSS/BLUE SHEILD
NC6002868Medicaid