Essential Wellness Counseling PLLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

ESSENTIAL WELLNESS COUNSELING PLLC

Practice address

4350 Main St Ste 213
Harrisburg, NC 28075-7448

Phone

(980) 236-1704

Fax

(980) 206-0709

NPI assigned

Jun 12, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Tyeekia Blue, LCSW, LCASNPI 1083153563

Title

Psychotherapist

Phone

(980) 236-1704

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Tyeekia Blue, MSW, LCSWA

  • Mental Health Counselor
  • Harrisburg, NC
  • NPI 1083153563
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1591920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1591920000000",
    "number": "1740805019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4350 MAIN ST STE 213",
            "city": "HARRISBURG",
            "state": "NC",
            "postal_code": "280757448",
            "telephone_number": "980-236-1704",
            "fax_number": "980-206-0709"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4350 MAIN ST STE 213",
            "city": "HARRISBURG",
            "state": "NC",
            "postal_code": "280757448",
            "telephone_number": "980-236-1704",
            "fax_number": "980-206-0709"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ESSENTIAL WELLNESS COUNSELING PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-12",
        "last_updated": "2020-06-12",
        "certification_date": "2020-06-12",
        "status": "A",
        "authorized_official_last_name": "BLUE",
        "authorized_official_first_name": "TYEEKIA",
        "authorized_official_title_or_position": "PSYCHOTHERAPIST",
        "authorized_official_telephone_number": "980-236-1704",
        "authorized_official_credential": "LCSW, LCAS"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1083153563",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Counselor in Harrisburg, NC
• Providers in Harrisburg, NC by specialty
• Mental Health Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.