Provider Demographics
NPI:1710699442
Name:ADULLAM COUNSELING SERVICES, PLLC
Entity Type:Organization
Organization Name:ADULLAM COUNSELING SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/ORGANIZER
Authorized Official - Prefix:MR
Authorized Official - First Name:EFCEL
Authorized Official - Middle Name:AARON
Authorized Official - Last Name:VELEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC
Authorized Official - Phone:605-415-5311
Mailing Address - Street 1:106 W RAINTREE LN
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-7362
Mailing Address - Country:US
Mailing Address - Phone:605-415-5311
Mailing Address - Fax:
Practice Address - Street 1:2906 HULL RD
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28504-8238
Practice Address - Country:US
Practice Address - Phone:252-582-0504
Practice Address - Fax:252-351-0343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-13
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1588153621Medicaid