Provider Demographics
NPI:1811464332
Name:PEACEFUL WATERS COUNSELING AND WELLNESS CENTER, P.C.
Entity type:Organization
Organization Name:PEACEFUL WATERS COUNSELING AND WELLNESS CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KAYLEE
Authorized Official - Middle Name:
Authorized Official - Last Name:BYNUM
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC, NCC, CCMHC
Authorized Official - Phone:252-232-8086
Mailing Address - Street 1:380 CARATOKE HWY STE J
Mailing Address - Street 2:
Mailing Address - City:MOYOCK
Mailing Address - State:NC
Mailing Address - Zip Code:27958-8623
Mailing Address - Country:US
Mailing Address - Phone:252-232-8086
Mailing Address - Fax:
Practice Address - Street 1:380 CARATOKE HWY STE J
Practice Address - Street 2:
Practice Address - City:MOYOCK
Practice Address - State:NC
Practice Address - Zip Code:27958-8623
Practice Address - Country:US
Practice Address - Phone:252-232-8086
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-01
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)