Provider Demographics
NPI:1285087270
Name:COUNSELING ASSOCIATES OF THE TRIAD, PLLC
Entity type:Organization
Organization Name:COUNSELING ASSOCIATES OF THE TRIAD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:KISZELY-BRESSLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-207-1955
Mailing Address - Street 1:301 S ELM ST
Mailing Address - Street 2:SUITE 505
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-2696
Mailing Address - Country:US
Mailing Address - Phone:336-355-8308
Mailing Address - Fax:336-245-4626
Practice Address - Street 1:7 RED FERN CT
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27455-2714
Practice Address - Country:US
Practice Address - Phone:336-207-1955
Practice Address - Fax:336-245-4626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-14
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YA0400X, 101YP2500X
NC8318101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6104650Medicaid