Provider Demographics
NPI:1972849065
Name:VANDERHALL COUNSELING SERVICES, PLLC
Entity Type:Organization
Organization Name:VANDERHALL COUNSELING SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPCS/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDERHALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-995-6279
Mailing Address - Street 1:1122 SAM NEWELL RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-5015
Mailing Address - Country:US
Mailing Address - Phone:866-598-3052
Mailing Address - Fax:
Practice Address - Street 1:1122 SAM NEWELL RD
Practice Address - Street 2:SUITE 105
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-5015
Practice Address - Country:US
Practice Address - Phone:704-995-6279
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-18
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCS3910101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty