Provider Demographics
NPI:1114421310
Name:THE INTERNATIONAL CENTER FOR WELLNESS COUNSELING AND CONSULTING
Entity Type:Organization
Organization Name:THE INTERNATIONAL CENTER FOR WELLNESS COUNSELING AND CONSULTING
Other - Org Name:LEKESHIA M LYNCH
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO-CLINICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LEKESHIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LYNCH
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW, LISW-CP
Authorized Official - Phone:704-699-9375
Mailing Address - Street 1:4311 SCHOOL HOUSE CMNS STE 140
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28075-7510
Mailing Address - Country:US
Mailing Address - Phone:704-699-9375
Mailing Address - Fax:
Practice Address - Street 1:140 CABARRUS AVE W
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-5150
Practice Address - Country:US
Practice Address - Phone:704-918-5494
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-21
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC122971041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1568899706Medicaid
NC1114421310Medicaid
SCSW1457Medicaid