1255608840 NPI number — PINNACLE COUNSELING SERVICES, PLLC

Table of content: (NPI 1255608840)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255608840 NPI number — PINNACLE COUNSELING SERVICES, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PINNACLE COUNSELING SERVICES, 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:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255608840
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/26/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 73081
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DURHAM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27722-3081
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-885-4046
Provider Business Mailing Address Fax Number:
919-477-1848

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
106 W CHURCH ST
Provider Second Line Business Practice Location Address:
SUITE H
Provider Business Practice Location Address City Name:
CREEDMOOR
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27522-9766
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-885-4046
Provider Business Practice Location Address Fax Number:
919-477-1848
Provider Enumeration Date:
11/26/2011

Additional Information

Authorized Official

Authorized Official Last Name:
MATHEWS
Authorized Official First Name:
TELINA
Authorized Official Middle Name:
F
Authorized Official Title or Position:
CLINICAL DIRECTOR/OWNER
Authorized Official Telephone Number:
919-302-5483

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  6824 , 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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