Provider Demographics
NPI:1710626023
Name:EXTRA PEACE COUNSELING PLLC
Entity Type:Organization
Organization Name:EXTRA PEACE COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:COUCH
Authorized Official - Last Name:LANIER
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC
Authorized Official - Phone:910-385-5613
Mailing Address - Street 1:2664 TIMBER DR # 344
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-2571
Mailing Address - Country:US
Mailing Address - Phone:910-385-5613
Mailing Address - Fax:
Practice Address - Street 1:4030 WAKE FOREST RD
Practice Address - Street 2:STE 349
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609
Practice Address - Country:US
Practice Address - Phone:910-385-5613
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-03
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty