Provider Demographics
NPI:1710508205
Name:BANNER CONSULTING AND COUNSELING OF NORTH CAROLINA, PLLC
Entity Type:Organization
Organization Name:BANNER CONSULTING AND COUNSELING OF NORTH CAROLINA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:DUKE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:912-335-9490
Mailing Address - Street 1:2525 RAEFORD RD STE B
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28305-5092
Mailing Address - Country:US
Mailing Address - Phone:910-491-8901
Mailing Address - Fax:910-891-8902
Practice Address - Street 1:2525 RAEFORD RD STE B
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5092
Practice Address - Country:US
Practice Address - Phone:910-491-8901
Practice Address - Fax:910-891-8902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-06
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty