Provider Demographics
NPI:1972120558
Name:WAYSTATION COUNSELING PLLC
Entity Type:Organization
Organization Name:WAYSTATION COUNSELING PLLC
Other - Org Name:WAYSTATION COUNSELING AND WELLNESS CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KORNOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-360-0116
Mailing Address - Street 1:4724 PARK RD STE A
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-4204
Mailing Address - Country:US
Mailing Address - Phone:704-218-9083
Mailing Address - Fax:980-237-7512
Practice Address - Street 1:4724 PARK RD STE A
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-4204
Practice Address - Country:US
Practice Address - Phone:704-218-9083
Practice Address - Fax:980-237-7512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-30
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty