Provider Demographics
NPI:1295216562
Name:SOUTHEAST COUNSELING SERVICES LLC
Entity type:Organization
Organization Name:SOUTHEAST COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PASTORAL PSYCHOTHERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WILEY
Authorized Official - Middle Name:EDGAR
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC, PSYD
Authorized Official - Phone:910-835-6653
Mailing Address - Street 1:6405 CAMDEN RD STE 109
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306-7584
Mailing Address - Country:US
Mailing Address - Phone:910-835-6653
Mailing Address - Fax:910-425-0013
Practice Address - Street 1:6405 CAMDEN RD STE 109
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28306-7584
Practice Address - Country:US
Practice Address - Phone:910-835-6653
Practice Address - Fax:910-425-0013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-24
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health