Provider Demographics
NPI:1376733352
Name:JOE HAZEL COUNSELING SERVICES
Entity Type:Organization
Organization Name:JOE HAZEL COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:HAZEL
Authorized Official - Suffix:
Authorized Official - Credentials:LCAS/CCS
Authorized Official - Phone:919-272-5881
Mailing Address - Street 1:274A W DEPOT ST
Mailing Address - Street 2:P.O. BOX 1893
Mailing Address - City:ANGIER
Mailing Address - State:NC
Mailing Address - Zip Code:27501-8861
Mailing Address - Country:US
Mailing Address - Phone:919-272-5881
Mailing Address - Fax:919-329-9848
Practice Address - Street 1:274A W DEPOT ST
Practice Address - Street 2:
Practice Address - City:ANGIER
Practice Address - State:NC
Practice Address - Zip Code:27501-8861
Practice Address - Country:US
Practice Address - Phone:919-272-5881
Practice Address - Fax:919-329-9848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC596101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6005582Medicaid
NC6111839Medicaid