Provider Demographics
NPI:1073732822
Name:COVENANT COUNSELING OF SOUTH CAROLINA
Entity Type:Organization
Organization Name:COVENANT COUNSELING OF SOUTH CAROLINA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:FAYE
Authorized Official - Middle Name:W,
Authorized Official - Last Name:WHITTEMORE
Authorized Official - Suffix:
Authorized Official - Credentials:MSW,LISW-CP
Authorized Official - Phone:843-851-1806
Mailing Address - Street 1:1851 DAWSON BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-5702
Mailing Address - Country:US
Mailing Address - Phone:843-851-1806
Mailing Address - Fax:843-821-7050
Practice Address - Street 1:1851 DAWSON BRANCH RD
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-5702
Practice Address - Country:US
Practice Address - Phone:843-851-1806
Practice Address - Fax:843-821-7050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
SC101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty