Provider Demographics
NPI:1821743964
Name:EXCAVATE COUNSELING & CONSULTING SERVICES PLLC
Entity Type:Organization
Organization Name:EXCAVATE COUNSELING & CONSULTING SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:CATHERINE
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:312-971-6844
Mailing Address - Street 1:4040 SPRING VALLEY RD APT 216D
Mailing Address - Street 2:
Mailing Address - City:FARMERS BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:75244-3810
Mailing Address - Country:US
Mailing Address - Phone:312-971-6844
Mailing Address - Fax:
Practice Address - Street 1:4040 SPRING VALLEY RD APT 216D
Practice Address - Street 2:
Practice Address - City:FARMERS BRANCH
Practice Address - State:TX
Practice Address - Zip Code:75244-3810
Practice Address - Country:US
Practice Address - Phone:312-971-6844
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-17
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty