Provider Demographics
NPI:1699809301
Name:AVALON COUNSELING CENTER, PLLC
Entity Type:Organization
Organization Name:AVALON COUNSELING CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:ORR
Authorized Official - Last Name:BELK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:919-468-9122
Mailing Address - Street 1:1230 SE MAYNARD RD STE 204
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-6945
Mailing Address - Country:US
Mailing Address - Phone:919-468-9122
Mailing Address - Fax:919-468-9122
Practice Address - Street 1:1230 SE MAYNARD RD STE 204
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-6945
Practice Address - Country:US
Practice Address - Phone:919-468-9122
Practice Address - Fax:919-468-9122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0037831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCA8774OtherMEDCOST PREFERRED
NC014WROtherBLUE CROSS
NC6005211Medicaid
NC014WROtherSTATE OF NC HEALTH PLAN
NC=========-003OtherCIGNA
NC6005211Medicaid
NC=========OtherAETNA
NC014WROtherBLUE CROSS
NC=========OtherTRICARE