Provider Demographics
NPI:1952606550
Name:CONNECTIVITY COUNSELING CENTER PLLC
Entity Type:Organization
Organization Name:CONNECTIVITY COUNSELING CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:910-829-6157
Mailing Address - Street 1:1608 RAMSEY ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28301-4410
Mailing Address - Country:US
Mailing Address - Phone:910-829-6157
Mailing Address - Fax:910-829-6158
Practice Address - Street 1:1608 RAMSEY ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-4410
Practice Address - Country:US
Practice Address - Phone:910-829-6157
Practice Address - Fax:910-829-6158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-13
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4606101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1679803449Medicaid