Provider Demographics
NPI:1487007563
Name:VIDA COUNSELING, PLLC
Entity Type:Organization
Organization Name:VIDA COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR SUP
Authorized Official - Prefix:DR
Authorized Official - First Name:HELOISA
Authorized Official - Middle Name:
Authorized Official - Last Name:PORTELA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LPCS, ACS, RPTS
Authorized Official - Phone:919-368-5207
Mailing Address - Street 1:6512 SIX FORKS RD
Mailing Address - Street 2:SUITE 403B
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-6561
Mailing Address - Country:US
Mailing Address - Phone:919-368-5207
Mailing Address - Fax:
Practice Address - Street 1:6512 SIX FORKS RD
Practice Address - Street 2:SUITE 403B
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-6561
Practice Address - Country:US
Practice Address - Phone:919-368-5207
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-13
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLPCS 4935101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty