| Counseling Associates At The Lake, Inc. | |
|
19501 W Catawba Ave Mailbox 10 Cornelius NC 28031-4017 | |
| (704) 301-5424 | |
| Not Available |
| Full Name | Counseling Associates At The Lake, Inc. |
|---|---|
| Speciality | Social Worker |
| Location | 19501 W Catawba Ave, Cornelius, North Carolina |
| Authorized Official Name and Position | Michelle Little Smith (OWNER/THERAPIST) |
| Authorized Official Contact | 7043015424 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Counseling Associates At The Lake, Inc. 19501 W Catawba Ave Mailbox 10 Cornelius NC 28031-4017 Ph: (704) 301-5424 | Counseling Associates At The Lake, Inc. 19501 W Catawba Ave Mailbox 10 Cornelius NC 28031-4017 Ph: (704) 301-5424 |
| NPI Number | 1023416146 |
|---|---|
| Provider Enumeration Date | 12/06/2014 |
| Last Update Date | 12/06/2014 |
| Medicare PECOS PAC ID | 4284953530 |
|---|---|
| Medicare Enrollment ID | O20150507001767 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023416146 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | COO2912 (North Carolina) | Primary |
| Provider Name | Philip J Deluca |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1164465530 PECOS PAC ID: 4284790841 Enrollment ID: I20090305000430 |
| Provider Name | Kristy L Seagren |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1699884635 PECOS PAC ID: 7618972944 Enrollment ID: I20090915000804 |
| Provider Name | Michelle L Smith |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1245372796 PECOS PAC ID: 8426277344 Enrollment ID: I20140908002116 |
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