Provider Demographics
NPI:1215590112
Name:HOUSE OF SUPPORT COUNSELING SERVICES, PLLC
Entity Type:Organization
Organization Name:HOUSE OF SUPPORT COUNSELING SERVICES, PLLC
Other - Org Name:HOUSE OF SUPPORT COUNSELING SERVICES, PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:POCHE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:919-200-5217
Mailing Address - Street 1:200 SUMMITT AVE
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-5026
Mailing Address - Country:US
Mailing Address - Phone:919-200-5217
Mailing Address - Fax:
Practice Address - Street 1:107 SE MAIN ST,
Practice Address - Street 2:STE. 317
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-4957
Practice Address - Country:US
Practice Address - Phone:919-200-5217
Practice Address - Fax:252-650-2214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-16
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty