Provider Demographics
NPI:1083816920
Name:REACH REHABILITATION & FAMILY COUNSELING SERVICES, INC
Entity Type:Organization
Organization Name:REACH REHABILITATION & FAMILY COUNSELING SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO & CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:NJUGUNA
Authorized Official - Last Name:NAGI
Authorized Official - Suffix:
Authorized Official - Credentials:EDS, DMIN, MDIV, MA
Authorized Official - Phone:803-333-9923
Mailing Address - Street 1:PO BOX 658
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-0658
Mailing Address - Country:US
Mailing Address - Phone:800-507-0394
Mailing Address - Fax:803-333-9926
Practice Address - Street 1:201 N TERRY ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:NC
Practice Address - Zip Code:28034-1742
Practice Address - Country:US
Practice Address - Phone:800-507-0394
Practice Address - Fax:803-333-9926
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REACH FAMILY COUNSELING SERVICES, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-04
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2344101Y00000X, 101YP2500X
101YA0400X, 101YP1600X, 106H00000X
SC2517101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty