# SOUTHFORK COUNSELING CENTER

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

## Provider details

- **NPI number:** 1740753730
- **Authorized official:** MR. JOSH TALLENT MA, ED.S, LPC, NCC (CLINICIAN/ CO-OWNER)
- **Authorized official phone:** (980) 284-2159

## Contact information

- **Practice address:** 701 S LAUREL ST STE 3, LINCOLNTON, NC 28092-3654
- **Practice address phone:** (704) 740-7044
- **Mailing address:** 701 S LAUREL ST STE 3, LINCOLNTON, NC 28092-3654
- **Mailing address phone:** (980) 284-2159
- **Mailing address fax:** (980) 284-2205

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | — | NULL | Yes |
| 101YM0800X | Mental Health Counselor | — | — | Yes |

## Other

- **Enumeration date:** 01/02/2019
- **Last updated:** 11/13/2019