Provider Demographics
NPI:1073054847
Name:COLUMBIA NORTHEAST COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:COLUMBIA NORTHEAST COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:W
Authorized Official - Last Name:PEEBLES
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LPC
Authorized Official - Phone:803-782-5556
Mailing Address - Street 1:PO BOX 25453
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29224-5453
Mailing Address - Country:US
Mailing Address - Phone:803-782-5556
Mailing Address - Fax:803-788-0914
Practice Address - Street 1:9570 TWO NOTCH RD
Practice Address - Street 2:SUITE #8
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-4308
Practice Address - Country:US
Practice Address - Phone:803-782-5556
Practice Address - Fax:803-788-0914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-13
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3157101YP2500X
SC89501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty