Provider Demographics
NPI:1306129994
Name:EMBRACE GROWTH COUNSELING AND CONSULTING SERVICES, PLLC
Entity type:Organization
Organization Name:EMBRACE GROWTH COUNSELING AND CONSULTING SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:SHENETHIA
Authorized Official - Middle Name:FENNER
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHCS
Authorized Official - Phone:910-227-9779
Mailing Address - Street 1:PO BOX 9834
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-9092
Mailing Address - Country:US
Mailing Address - Phone:910-227-9779
Mailing Address - Fax:
Practice Address - Street 1:305 ABBOTTSWOOD DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-3369
Practice Address - Country:US
Practice Address - Phone:910-227-9779
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-21
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty