Provider Demographics
NPI:1144724980
Name:SELF-TALK COUNSELING & CONSULTING, PLLC
Entity type:Organization
Organization Name:SELF-TALK COUNSELING & CONSULTING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAREEM
Authorized Official - Middle Name:C
Authorized Official - Last Name:PURANDA
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHCS, LCAS, NCC
Authorized Official - Phone:980-234-5464
Mailing Address - Street 1:3126 MILTON RD STE 234
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-3782
Mailing Address - Country:US
Mailing Address - Phone:980-285-3689
Mailing Address - Fax:866-313-6091
Practice Address - Street 1:3126 MILTON RD STE 234
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-3782
Practice Address - Country:US
Practice Address - Phone:980-285-2689
Practice Address - Fax:866-313-6091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-19
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty