Provider Demographics
NPI:1831658285
Name:SALEM COUNSELING CENTER, PLLC
Entity Type:Organization
Organization Name:SALEM COUNSELING CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:CHASE
Authorized Official - Last Name:SALMONS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:336-416-1912
Mailing Address - Street 1:1959 N PEACE HAVEN RD STE 123
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-4850
Mailing Address - Country:US
Mailing Address - Phone:336-934-4670
Mailing Address - Fax:
Practice Address - Street 1:203 S STRATFORD RD STE A
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1872
Practice Address - Country:US
Practice Address - Phone:336-934-4670
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-15
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty