Organization
CN3
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CLYDE CARSON NANCE (OWNER)
(843) 496-4756
Entity
Organization
Contact information
Practice address
1670 FALLEN LEAF LN # D, WILMINGTON, NC 28403-5594
(843) 496-4756
Mailing address
1670 FALLEN LEAF LN # D, WILMINGTON, NC 28403-5594
(843) 496-4756
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
—
Other
Enumeration date
10/20/2023
Last updated
11/17/2023
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