Provider Demographics
NPI:1487542585
Name:MOUNTAINS TO LAKE COUNSELING, PLLC
Entity type:Organization
Organization Name:MOUNTAINS TO LAKE COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:GREGA
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LCMHC
Authorized Official - Phone:704-677-5479
Mailing Address - Street 1:129 SEA TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-8493
Mailing Address - Country:US
Mailing Address - Phone:704-677-5479
Mailing Address - Fax:
Practice Address - Street 1:129 SEA TRAIL DR
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-8493
Practice Address - Country:US
Practice Address - Phone:704-677-5479
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-26
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty