Basic Information
| Provider Information | |||||||||
| NPI: | 1609527829 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COLLECTIVE COUNSELING, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8 DUNNBERRY CT | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274552575 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9108903470 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2307 W CONE BLVD STE 204B | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274084027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9108903470 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2022 | ||||||||
| LastUpdateDate: | 01/11/2022 | ||||||||
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| AuthorizedOfficialLastName: | RAYNOR | ||||||||
| AuthorizedOfficialFirstName: | ERIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | MARRIAGE AND FAMILY THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 9108903470 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | LMFT | ||||||||
| NPICertificationDate: | 01/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
No ID Information.