| Organization Name: | SOUTHLAKE COUNSELING & CONSULTING |
| NPI Number: | 1194864975 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KIMBERLY B KRUEGER (DIRECTOR) |
| Mailing Address: | 903 Northeast Dr Ste 201 Davidson |
| State: | NC US |
| Postal Code: | 280367438 |
| Phone Number: | 7048967776 |
| Fax Number: | 7048960992 |
| NPI Enumeration Date: | 02/06/2007 |
| NPI Last Update Date: | 06/23/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | C004574 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NC |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |