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Organization
INDEPENDENCE COUNSELING AND CONSULTING SERVICES, PLLC
Active
Organization
INDEPENDENCE COUNSELING AND CONSULTING SERVICES, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIFFANY SHAW LPC, NCC, LCAS (DIRECTOR)
(910) 261-4635
Entity
Organization
Contact information
Practice address
946 MOCKINGBIRD HILL RD, RAEFORD, NC 28376-6363
(910) 261-4635
Mailing address
946 MOCKINGBIRD HILL RD, RAEFORD, NC 28376-6363
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
7366
NC
Other
Enumeration date
12/19/2012
Last updated
12/19/2012
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