Provider Demographics
NPI:1922521590
Name:UNDER THE WILLOW COUNSELING
Entity Type:Organization
Organization Name:UNDER THE WILLOW COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SNIPES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:919-438-1756
Mailing Address - Street 1:8004 STRAWBERRY MEADOWS ST
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-1043
Mailing Address - Country:US
Mailing Address - Phone:919-819-5735
Mailing Address - Fax:
Practice Address - Street 1:8410 SIX FORKS RD STE 203
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-3078
Practice Address - Country:US
Practice Address - Phone:919-438-1756
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-25
Last Update Date:2017-07-25
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
NC1952715021Medicaid