Provider Demographics
NPI:1124817382
Name:CARDINAL COUNSELING CONNECTION
Entity type:Organization
Organization Name:CARDINAL COUNSELING CONNECTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC
Authorized Official - Phone:219-201-3328
Mailing Address - Street 1:102 W CARDWELL ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:NC
Mailing Address - Zip Code:27025-1704
Mailing Address - Country:US
Mailing Address - Phone:219-201-3328
Mailing Address - Fax:
Practice Address - Street 1:717 GREEN VALLEY RD STE 206
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-2156
Practice Address - Country:US
Practice Address - Phone:336-517-7120
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)