Provider Demographics
NPI:1467690586
Name:ACME COUNSELING CENTER
Entity Type:Organization
Organization Name:ACME COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OUTPATIENT MENTAL HEALTH THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:EVANGELINE
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:919-491-3115
Mailing Address - Street 1:8 BENTWOOD PL
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-2640
Mailing Address - Country:US
Mailing Address - Phone:919-491-3115
Mailing Address - Fax:
Practice Address - Street 1:3711 UNIVERSITY DR STE B
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-2654
Practice Address - Country:US
Practice Address - Phone:919-491-3115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-27
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7125251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6104016Medicaid