Provider Demographics
NPI:1902500812
Name:INTENTIONAL STEPS COUNSELING SERVICES, PLLC
Entity type:Organization
Organization Name:INTENTIONAL STEPS COUNSELING SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHERRONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BANKS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSWA
Authorized Official - Phone:704-726-0644
Mailing Address - Street 1:8811 LEGACY PARK DR APT J
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-9627
Mailing Address - Country:US
Mailing Address - Phone:704-726-0644
Mailing Address - Fax:
Practice Address - Street 1:701 ATANDO AVE STE L
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28206-1902
Practice Address - Country:US
Practice Address - Phone:704-726-0644
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-27
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty