| Kingdom Creative Counseling Pllc | |
|
1050 Revolution Mill Dr Ste 2 Greensboro NC 27405-5053 | |
| (336) 543-0159 | |
| (336) 663-2906 |
| Full Name | Kingdom Creative Counseling Pllc |
|---|---|
| Speciality | Counselor |
| Location | 1050 Revolution Mill Dr Ste 2, Greensboro, North Carolina |
| Authorized Official Name and Position | Samaria M Colbert (OWNER) |
| Authorized Official Contact | 3365430159 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kingdom Creative Counseling Pllc Po Box 14222 Greensboro NC 27415-4222 Ph: (336) 543-0159 | Kingdom Creative Counseling Pllc 1050 Revolution Mill Dr Ste 2 Greensboro NC 27405-5053 Ph: (336) 543-0159 |
| NPI Number | 1700313780 |
|---|---|
| Provider Enumeration Date | 05/22/2017 |
| Last Update Date | 08/06/2023 |
| Certification Date | 08/06/2023 |
| Medicare PECOS PAC ID | 3577830116 |
|---|---|
| Medicare Enrollment ID | O20170601002090 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700313780 | NPI | - | NPPES |
| 1699077396 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | C007049 (North Carolina) | Primary |
| 101YP2500X | Counselor - Professional | C007049 (North Carolina) | Secondary |
| Provider Name | Samaria M Colbert |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1699077396 PECOS PAC ID: 0143401455 Enrollment ID: I20110221000082 |
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