Provider Demographics
NPI:1346987302
Name:THE HEALING CENTER COUNSELING & CONSULTING SERVICES PLLC
Entity Type:Organization
Organization Name:THE HEALING CENTER COUNSELING & CONSULTING SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MASTER ADDICTION COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:SHENIKA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:BORDEAUX-COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-261-2455
Mailing Address - Street 1:1531 32ND AVE S STE 105
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-5910
Mailing Address - Country:US
Mailing Address - Phone:701-261-2455
Mailing Address - Fax:
Practice Address - Street 1:1531 32ND AVE S STE 102
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-5911
Practice Address - Country:US
Practice Address - Phone:701-261-2455
Practice Address - Fax:701-532-1447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-19
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty