Provider Demographics
NPI:1346807377
Name:UN-BOUND COUNSELING SERVICE, PLLC
Entity Type:Organization
Organization Name:UN-BOUND COUNSELING SERVICE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPCA
Authorized Official - Phone:910-334-1174
Mailing Address - Street 1:PO BOX 1832
Mailing Address - Street 2:
Mailing Address - City:ROCKINGHAM
Mailing Address - State:NC
Mailing Address - Zip Code:28380-1832
Mailing Address - Country:US
Mailing Address - Phone:910-334-1174
Mailing Address - Fax:
Practice Address - Street 1:801 E BROAD AVE STE 12
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:NC
Practice Address - Zip Code:28379-4382
Practice Address - Country:US
Practice Address - Phone:910-334-1174
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-24
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCA13480OtherLICENSED PROFESSIONAL COUNSELOR ASSOCIATE