Provider Demographics
NPI:1518323658
Name:REHOBOTH COUNSELING SERVICES
Entity Type:Organization
Organization Name:REHOBOTH COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TAUNYA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:QUEEN-MELENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:252-332-8700
Mailing Address - Street 1:PO BOX 57
Mailing Address - Street 2:
Mailing Address - City:AHOSKIE
Mailing Address - State:NC
Mailing Address - Zip Code:27910-0057
Mailing Address - Country:US
Mailing Address - Phone:252-332-8700
Mailing Address - Fax:
Practice Address - Street 1:415 HOLLOMAN AVE E
Practice Address - Street 2:
Practice Address - City:AHOSKIE
Practice Address - State:NC
Practice Address - Zip Code:27910-2314
Practice Address - Country:US
Practice Address - Phone:252-332-8700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-05
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6103958Medicaid