Provider Demographics
NPI:1881340750
Name:ACTIVE WELLNESS COUNSELING, PLLC
Entity type:Organization
Organization Name:ACTIVE WELLNESS COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:SEANA
Authorized Official - Middle Name:C
Authorized Official - Last Name:PERNICE-KOWALCZYK
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC
Authorized Official - Phone:910-603-1856
Mailing Address - Street 1:180 HORIZON TRL
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:NC
Mailing Address - Zip Code:28315-7423
Mailing Address - Country:US
Mailing Address - Phone:910-603-1856
Mailing Address - Fax:
Practice Address - Street 1:180 HORIZON TRL
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:NC
Practice Address - Zip Code:28315-7423
Practice Address - Country:US
Practice Address - Phone:910-603-1856
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-01
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty