Provider Demographics
NPI:1891297230
Name:CPL COUNSELING & CONSULTING SERVICES
Entity Type:Organization
Organization Name:CPL COUNSELING & CONSULTING SERVICES
Other - Org Name:CPL COUNSELING & CONSULTING SERVICES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:PAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-384-8139
Mailing Address - Street 1:1016 W EHRINGHAUS ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-4959
Mailing Address - Country:US
Mailing Address - Phone:252-384-8139
Mailing Address - Fax:252-557-3549
Practice Address - Street 1:1016 W EHRINGHAUS ST
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-4959
Practice Address - Country:US
Practice Address - Phone:252-384-8139
Practice Address - Fax:252-557-3549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-01
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20639101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1205340734Medicaid