Provider Demographics
NPI:1295111581
Name:CHRYSALIS COUNSELING AND CONSULTATION CENTER, INC,
Entity type:Organization
Organization Name:CHRYSALIS COUNSELING AND CONSULTATION CENTER, INC,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR / COUNSELOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:KLING
Authorized Official - Suffix:
Authorized Official - Credentials:D MIN, LPC
Authorized Official - Phone:336-852-0626
Mailing Address - Street 1:612 PASTEUR DRIVE
Mailing Address - Street 2:SUITE 405
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27403-1120
Mailing Address - Country:US
Mailing Address - Phone:336-852-0626
Mailing Address - Fax:336-856-7703
Practice Address - Street 1:612 PASTEUR DR
Practice Address - Street 2:SUITE 405
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403-1149
Practice Address - Country:US
Practice Address - Phone:336-852-0626
Practice Address - Fax:336-856-7703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-10
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2390101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty