Provider Demographics
NPI:1649431719
Name:SUNDANCE CONSULTANTS,INC.
Entity type:Organization
Organization Name:SUNDANCE CONSULTANTS,INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:H.
Authorized Official - Middle Name:MAC
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:1800-563-1282
Mailing Address - Street 1:923 CHADWICK SHORES DR
Mailing Address - Street 2:
Mailing Address - City:SNEADS FERRY
Mailing Address - State:NC
Mailing Address - Zip Code:28460-9213
Mailing Address - Country:US
Mailing Address - Phone:910-327-3631
Mailing Address - Fax:910-327-2616
Practice Address - Street 1:923 CHADWICK SHORES DR
Practice Address - Street 2:
Practice Address - City:SNEADS FERRY
Practice Address - State:NC
Practice Address - Zip Code:28460-9213
Practice Address - Country:US
Practice Address - Phone:910-327-3631
Practice Address - Fax:910-327-2616
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUNDANCE CONSULTANTS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-21
Last Update Date:2008-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC363251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health