Provider Demographics
NPI:1992369680
Name:EVERGREEN COUNSELING AND WELLNESS, PLLC
Entity Type:Organization
Organization Name:EVERGREEN COUNSELING AND WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:KACERE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:515-975-6362
Mailing Address - Street 1:895 STATE FARM RD STE 507-5
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-4917
Mailing Address - Country:US
Mailing Address - Phone:828-338-3136
Mailing Address - Fax:
Practice Address - Street 1:895 STATE FARM RD STE 507-5
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-4917
Practice Address - Country:US
Practice Address - Phone:828-338-3136
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-28
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty