Provider Demographics
NPI:1689274292
Name:TRANSFORMATION COUNSELING & CONSULTING
Entity Type:Organization
Organization Name:TRANSFORMATION COUNSELING & CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:JANEEN
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC
Authorized Official - Phone:919-306-2579
Mailing Address - Street 1:PO BOX 627
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27588-0627
Mailing Address - Country:US
Mailing Address - Phone:919-306-2579
Mailing Address - Fax:
Practice Address - Street 1:3041 BERKS WAY STE 102C
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-6777
Practice Address - Country:US
Practice Address - Phone:919-925-2274
Practice Address - Fax:919-820-8571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-01
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty