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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