Basic Information
| Provider Information | |||||||||
| NPI: | 1427529155 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WELLNESS WITHIN PROFESSIONAL COUNSELING | ||||||||
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| Mailing Information | |||||||||
| Address1: | 111 SHORE DR | ||||||||
| Address2: | |||||||||
| City: | SHILOH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 279746241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2523394915 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2400 N CROATAN HWY STE F | ||||||||
| Address2: | |||||||||
| City: | KILL DEVIL HILLS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 279489356 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2523394915 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2018 | ||||||||
| LastUpdateDate: | 12/17/2018 | ||||||||
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| AuthorizedOfficialLastName: | DUNAVANT | ||||||||
| AuthorizedOfficialFirstName: | KATHERINE | ||||||||
| AuthorizedOfficialMiddleName: | LYNN | ||||||||
| AuthorizedOfficialTitleorPosition: | LICENSED PROFESSIONAL COUNSELOR | ||||||||
| AuthorizedOfficialTelephone: | 2523394915 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LPC, NCC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.