Provider Demographics
NPI:1699132357
Name:SUPPORTIVE COUNSELING SERVICES, PLLC
Entity type:Organization
Organization Name:SUPPORTIVE COUNSELING SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SAMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:HANEF
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW, LISWCP
Authorized Official - Phone:919-358-1471
Mailing Address - Street 1:14 CONSULTANT PL
Mailing Address - Street 2:SUITE 210 A
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-6320
Mailing Address - Country:US
Mailing Address - Phone:919-358-1471
Mailing Address - Fax:919-287-2556
Practice Address - Street 1:14 CONSULTANT PL
Practice Address - Street 2:SUITE 210 A
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-6320
Practice Address - Country:US
Practice Address - Phone:919-358-1471
Practice Address - Fax:919-287-2556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-26
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2759A101YM0800X
NCC0081521041C0700X
SC113441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty