Provider Demographics
NPI:1396225348
Name:REAL TALK COUNSELING
Entity Type:Organization
Organization Name:REAL TALK COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TAMEKA
Authorized Official - Middle Name:WADE
Authorized Official - Last Name:BREWINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LCAS, LPC
Authorized Official - Phone:980-939-0991
Mailing Address - Street 1:2128 MCCLINTOCK RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-5114
Mailing Address - Country:US
Mailing Address - Phone:980-939-0991
Mailing Address - Fax:703-731-0980
Practice Address - Street 1:2128 MCCLINTOCK RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-5114
Practice Address - Country:US
Practice Address - Phone:980-939-0991
Practice Address - Fax:704-731-0980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-20
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA13234261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)