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Organization

EAGLE EYE COUNSELING & CONSULTING, PLLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
LILY MUDRY LPC-S, LCAS, CCS (OWNER)
(704) 750-1007
Entity
Organization

Contact information

Practice address
1118 SAM NEWELL RD, MATTHEWS, NC 28105-5041
(704) 750-1007
Mailing address
1775 APPLE TREE LN, FORT MILL, SC 29715-9100
(704) 421-4746

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
7638
NC
101YA0400X
Addiction (Substance Use Disorder) Counselor
1717
NC
101YM0800X
Mental Health Counselor
Primary
S7638
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1366755282
NC
Enumeration date
02/08/2017
Last updated
02/08/2017
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