# PREMIER COUNSELING GROUP PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104364835
- **Authorized official:** TAVARES ANTWAN BOSTIC LCSW (PRESIDENT)
- **Authorized official phone:** (585) 967-8396

## Contact information

- **Practice address:** 201 STROMAN RD, MARSTON, NC 28363-9501
- **Practice address phone:** (585) 967-8396
- **Practice address fax:** (910) 491-9715
- **Mailing address:** 801 E BROAD AVE, STE 18, ROCKINGHAM, NC 28379-4383
- **Mailing address phone:** (585) 967-8396
- **Mailing address fax:** (910) 491-9715

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251S00000X | Community/Behavioral Health Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 02/01/2017
- **Last updated:** 02/01/2017