Provider Demographics
NPI:1124525845
Name:COTTONWOOD COUNSELING & CONSULTING, PLLC
Entity type:Organization
Organization Name:COTTONWOOD COUNSELING & CONSULTING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JASMINE
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:EATMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCAS, LPC
Authorized Official - Phone:704-550-7220
Mailing Address - Street 1:431 RIDGE ST
Mailing Address - Street 2:
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28001-4346
Mailing Address - Country:US
Mailing Address - Phone:704-550-7220
Mailing Address - Fax:
Practice Address - Street 1:431 RIDGE ST
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-4346
Practice Address - Country:US
Practice Address - Phone:704-550-7220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-09
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2626101YA0400X
NC8673101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty