Provider Demographics
NPI:1487119442
Name:BYRD COUNSELING & CONSULTING, PLLC
Entity type:Organization
Organization Name:BYRD COUNSELING & CONSULTING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATRICE
Authorized Official - Middle Name:LACHELLE
Authorized Official - Last Name:BYRD
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:678-522-5729
Mailing Address - Street 1:5119 INGLEBURN LN
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-7760
Mailing Address - Country:US
Mailing Address - Phone:678-522-5729
Mailing Address - Fax:
Practice Address - Street 1:18151 W CATAWBA AVE
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-5641
Practice Address - Country:US
Practice Address - Phone:704-621-4308
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-04
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1487194692Medicaid
SC1487194692Medicaid
NC1487119442Medicaid