Provider Demographics
NPI:1902048432
Name:COHESIVE COUNSELING SERVICES, PLLC
Entity Type:Organization
Organization Name:COHESIVE COUNSELING SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARMELLA
Authorized Official - Middle Name:DIXON
Authorized Official - Last Name:CREWS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:704-951-4053
Mailing Address - Street 1:PO BOX 142
Mailing Address - Street 2:
Mailing Address - City:MT HOLLY
Mailing Address - State:NC
Mailing Address - Zip Code:28120-0142
Mailing Address - Country:US
Mailing Address - Phone:704-951-4053
Mailing Address - Fax:267-427-8628
Practice Address - Street 1:625 E 2ND AVE
Practice Address - Street 2:SUITE 9
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-0470
Practice Address - Country:US
Practice Address - Phone:704-701-6053
Practice Address - Fax:512-682-1553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-30
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4629101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102807Medicaid