Provider Demographics
NPI:1184368680
Name:PEACEFUL BALANCE COUNSELING, PLLC
Entity type:Organization
Organization Name:PEACEFUL BALANCE COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:G
Authorized Official - Last Name:KEMLAGE
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LCMHC
Authorized Official - Phone:508-273-5542
Mailing Address - Street 1:801 WINDGATE DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-3086
Mailing Address - Country:US
Mailing Address - Phone:508-273-5542
Mailing Address - Fax:
Practice Address - Street 1:4900 RANDALL PKWY STE J
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-2831
Practice Address - Country:US
Practice Address - Phone:910-216-9113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-21
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health