1154809879 NPI number — COHESIVE COUNSELING ASSOCIATES PLLC

Table of content: (NPI 1154809879)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154809879 NPI number — COHESIVE COUNSELING ASSOCIATES PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COHESIVE COUNSELING ASSOCIATES PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
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Provider Other Credential Text:
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NPI Number Information

NPI Number:
1154809879
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/06/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7427 MATTHEWS MINT HILL RD STE 105
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MINT HILL
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28227-7863
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-957-3865
Provider Business Mailing Address Fax Number:
704-910-3542

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2210 CORONATION BLVD
Provider Second Line Business Practice Location Address:
STE C
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28227-6799
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-957-3865
Provider Business Practice Location Address Fax Number:
704-910-3542
Provider Enumeration Date:
08/03/2018

Additional Information

Authorized Official

Authorized Official Last Name:
TATE-SCRUSE
Authorized Official First Name:
MELISSA
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PROPRIETOR, CLINICIAN
Authorized Official Telephone Number:
704-957-8568

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  S9529 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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