Provider Demographics
NPI:1659963114
Name:IMMERSE COUNSELING AND CONSULTING
Entity Type:Organization
Organization Name:IMMERSE COUNSELING AND CONSULTING
Other - Org Name:IMMERSE COUNSELING AND CONSULTING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MENTAL HEALTH THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ALANA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARPER
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC
Authorized Official - Phone:704-389-0330
Mailing Address - Street 1:801 E MOREHEAD STREET
Mailing Address - Street 2:SUITE 105 #3071
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28202
Mailing Address - Country:US
Mailing Address - Phone:704-389-0330
Mailing Address - Fax:704-817-3107
Practice Address - Street 1:5200 PARK RD STE 200
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-3650
Practice Address - Country:US
Practice Address - Phone:704-389-0330
Practice Address - Fax:704-817-3107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-06
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1487185989Medicaid
NC1487185989OtherBLUE CROSS BLUE SHILED, AETNA, UNITED HEALTH CARE