Provider Demographics
NPI:1942887989
Name:ALLIANCE CLINICAL COUNSELING, PLLC
Entity Type:Organization
Organization Name:ALLIANCE CLINICAL COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNA
Authorized Official - Middle Name:
Authorized Official - Last Name:PERUSEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-618-5370
Mailing Address - Street 1:920 CAMERON CT
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28112-6191
Mailing Address - Country:US
Mailing Address - Phone:704-618-5370
Mailing Address - Fax:
Practice Address - Street 1:108 BLYTHE MILL RD
Practice Address - Street 2:
Practice Address - City:WAXHAW
Practice Address - State:NC
Practice Address - Zip Code:28173-7696
Practice Address - Country:US
Practice Address - Phone:704-618-5370
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-25
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)