Provider Demographics
NPI:1740059591
Name:THE COUNSELOR WELLNESS CENTER, PLLC
Entity type:Organization
Organization Name:THE COUNSELOR WELLNESS CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCMHC /PRACTICE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAZZMEN
Authorized Official - Middle Name:NIKOLE
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC
Authorized Official - Phone:470-709-3822
Mailing Address - Street 1:2108 SOUTH BLVD STE 211-1058
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-5043
Mailing Address - Country:US
Mailing Address - Phone:704-208-4667
Mailing Address - Fax:704-200-2686
Practice Address - Street 1:2108 SOUTH BLVD STE 211-1058
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5043
Practice Address - Country:US
Practice Address - Phone:704-208-4667
Practice Address - Fax:704-200-2686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-21
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty