Provider Demographics
NPI:1467747030
Name:FOSTERING REAL CHANGE COUNSELING SERVICES, INC.
Entity Type:Organization
Organization Name:FOSTERING REAL CHANGE COUNSELING SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DAYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BENEDETTI
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:828-376-0000
Mailing Address - Street 1:PO BOX 1426
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28793-1426
Mailing Address - Country:US
Mailing Address - Phone:828-376-0000
Mailing Address - Fax:828-376-0000
Practice Address - Street 1:220 3RD AVE W
Practice Address - Street 2:SUITE A
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28739-4330
Practice Address - Country:US
Practice Address - Phone:828-376-0000
Practice Address - Fax:828-376-0000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7302101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6104476Medicaid