Basic Information
| Provider Information | |||||||||
| NPI: | 1497419600 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CYPRESS COUNSELING CENTER, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5614 ROCKFISH RD | ||||||||
| Address2: | |||||||||
| City: | HOPE MILLS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283481845 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9105510835 | ||||||||
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| Address1: | 5614 ROCKFISH RD | ||||||||
| Address2: | |||||||||
| City: | HOPE MILLS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283481845 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9105510835 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2021 | ||||||||
| LastUpdateDate: | 10/25/2021 | ||||||||
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| AuthorizedOfficialLastName: | DEPIETRO | ||||||||
| AuthorizedOfficialFirstName: | CRYSTAL | ||||||||
| AuthorizedOfficialMiddleName: | GAYNELL | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9105510835 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LCSW, CCM | ||||||||
| NPICertificationDate: | 10/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | N | Agencies | Case Management | 261QM0801X | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
No ID Information.