Provider Demographics
NPI:1053154195
Name:INTENTIONAL PRACTICE COUNSELING & WELLNESS, PLLC
Entity type:Organization
Organization Name:INTENTIONAL PRACTICE COUNSELING & WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOBLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW, LICSW
Authorized Official - Phone:919-823-3519
Mailing Address - Street 1:2813 NEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-5485
Mailing Address - Country:US
Mailing Address - Phone:252-944-3544
Mailing Address - Fax:
Practice Address - Street 1:150 PROVIDENCE RD STE 100
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-2208
Practice Address - Country:US
Practice Address - Phone:919-823-3519
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)