| Direct Realistic Counseling Service | |
|
503 Highway 70 Suite R Garner NC 27529 | |
| (919) 706-9448 | |
| Not Available |
| Full Name | Direct Realistic Counseling Service |
|---|---|
| Speciality | Counselor |
| Location | 503 Highway 70, Garner, North Carolina |
| Authorized Official Name and Position | Damen Raheem Cromwell (OWNER) |
| Authorized Official Contact | 9193329294 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Direct Realistic Counseling Service 212 Crestdale Dr Clayton NC 27520-5515 Ph: (919) 706-9448 | Direct Realistic Counseling Service 503 Highway 70 Suite R Garner NC 27529 Ph: (919) 706-9448 |
| NPI Number | 1760039937 |
|---|---|
| Provider Enumeration Date | 08/22/2019 |
| Last Update Date | 12/22/2020 |
| Certification Date | 12/17/2020 |
| Medicare PECOS PAC ID | 4688074925 |
|---|---|
| Medicare Enrollment ID | O20210608003238 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760039937 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Secondary |
| Provider Name | Juanita Consuela Perkins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225163744 PECOS PAC ID: 6305978982 Enrollment ID: I20100716000641 |
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