Provider Demographics
NPI:1811531429
Name:ANIWAYA COUNSELING PLLC
Entity type:Organization
Organization Name:ANIWAYA COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MH PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:NICHOLE
Authorized Official - Last Name:CROWE
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:828-273-8108
Mailing Address - Street 1:4648 KIPLING DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28212-5332
Mailing Address - Country:US
Mailing Address - Phone:828-273-8108
Mailing Address - Fax:704-582-6207
Practice Address - Street 1:202 S OLD STATESVILLE RD
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-9700
Practice Address - Country:US
Practice Address - Phone:828-273-8108
Practice Address - Fax:704-582-6207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-06
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1164824843Medicaid