Provider Demographics
NPI:1053140541
Name:ALDER GROVE COUNSELING COLLABORATIVE, PLLC
Entity type:Organization
Organization Name:ALDER GROVE COUNSELING COLLABORATIVE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:DENINE
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LCMHCS, LCAS
Authorized Official - Phone:336-391-2803
Mailing Address - Street 1:6255 TOWNCENTER DR STE 886
Mailing Address - Street 2:
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012-9376
Mailing Address - Country:US
Mailing Address - Phone:336-391-2803
Mailing Address - Fax:
Practice Address - Street 1:5939 FRYE BRIDGE RD
Practice Address - Street 2:
Practice Address - City:CLEMMONS
Practice Address - State:NC
Practice Address - Zip Code:27012-9600
Practice Address - Country:US
Practice Address - Phone:336-391-2803
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty