Provider Demographics
NPI:1255580064
Name:BCH COUNSELING & CONSULTATION SERVICES
Entity type:Organization
Organization Name:BCH COUNSELING & CONSULTATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMEKA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC
Authorized Official - Phone:704-676-4884
Mailing Address - Street 1:4108 PARK RD
Mailing Address - Street 2:SUITE 325
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-2259
Mailing Address - Country:US
Mailing Address - Phone:704-676-4884
Mailing Address - Fax:
Practice Address - Street 1:4108 PARK RD
Practice Address - Street 2:SUITE 325
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-2259
Practice Address - Country:US
Practice Address - Phone:704-676-4884
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-17
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5007101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102903Medicaid
NC6103824Medicaid