Provider Demographics
NPI:1558022038
Name:KISHA NORMAN PROFESSIONAL COUNSELING SERVICES PLLC
Entity Type:Organization
Organization Name:KISHA NORMAN PROFESSIONAL COUNSELING SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWN/CONSELOR
Authorized Official - Prefix:
Authorized Official - First Name:KISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:NORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHCA, LCASA, NCC
Authorized Official - Phone:252-394-1381
Mailing Address - Street 1:PO BOX 264
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:NC
Mailing Address - Zip Code:27925-0264
Mailing Address - Country:US
Mailing Address - Phone:252-394-1381
Mailing Address - Fax:
Practice Address - Street 1:1841 NEWLANDS RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:NC
Practice Address - Zip Code:27925-8035
Practice Address - Country:US
Practice Address - Phone:252-394-1381
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-06
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health