Provider Demographics
NPI:1922871730
Name:THE COUNSELING CLINIC
Entity Type:Organization
Organization Name:THE COUNSELING CLINIC
Other - Org Name:THE COUNSELING CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TROY
Authorized Official - Middle Name:T
Authorized Official - Last Name:KANE
Authorized Official - Suffix:
Authorized Official - Credentials:LCMCHS
Authorized Official - Phone:919-880-5694
Mailing Address - Street 1:PO BOX 99036
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27624-9036
Mailing Address - Country:US
Mailing Address - Phone:919-880-5694
Mailing Address - Fax:
Practice Address - Street 1:811 N MAIN STREET
Practice Address - Street 2:
Practice Address - City:CREEDMOOR
Practice Address - State:NC
Practice Address - Zip Code:27524
Practice Address - Country:US
Practice Address - Phone:919-880-5694
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-02
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1184701286Medicaid