Provider Demographics
NPI:1033755194
Name:UPSTATE CAROLINA COUNSELING ASSOCIATES
Entity Type:Organization
Organization Name:UPSTATE CAROLINA COUNSELING ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:TALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC/S
Authorized Official - Phone:864-644-8251
Mailing Address - Street 1:405A E 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29640-3062
Mailing Address - Country:US
Mailing Address - Phone:864-644-8251
Mailing Address - Fax:864-644-8253
Practice Address - Street 1:405A E 1ST AVE
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29640-3062
Practice Address - Country:US
Practice Address - Phone:864-644-8251
Practice Address - Fax:864-644-8253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-25
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPC1435Medicaid