| Queer Wave Counseling, Pllc | |
| 766 Moores Pond Rd Youngsville NC 27596-8199 | |
| (919) 236-3211 | |
| Not Available | 
| Full Name | Queer Wave Counseling, Pllc | 
|---|---|
| Speciality | Clinic/center - Adult Mental Health | 
| Location | 766 Moores Pond Rd, Youngsville, North Carolina | 
| Authorized Official Name and Position | Jeffrey Licalzi (OWNER/PSYCHOTHERAPIST) | 
| Authorized Official Contact | 9192363211 | 
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. | 
| Mailing Address | Practice Location Address | 
|---|---|
| Queer Wave Counseling, Pllc 766 Moores Pond Rd Youngsville NC 27596-8199 Ph: (919) 236-3211 | Queer Wave Counseling, Pllc 766 Moores Pond Rd Youngsville NC 27596-8199 Ph: (919) 236-3211 | 
| NPI Number | 1114675998 | 
|---|---|
| Provider Enumeration Date | 03/11/2022 | 
| Last Update Date | 03/11/2022 | 
| Certification Date | 03/11/2022 | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1114675998 | NPI | - | NPPES | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary | 
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