Provider Demographics
NPI:1093916090
Name:CLEMSON COUNSELING CENTER, INC.
Entity Type:Organization
Organization Name:CLEMSON COUNSELING CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:DAVENPORT
Authorized Official - Last Name:EBERHART
Authorized Official - Suffix:
Authorized Official - Credentials:M ED, LPC
Authorized Official - Phone:864-654-0322
Mailing Address - Street 1:1011 TIGER BLVD
Mailing Address - Street 2:SUITE 610
Mailing Address - City:CLEMSON
Mailing Address - State:SC
Mailing Address - Zip Code:29631-2915
Mailing Address - Country:US
Mailing Address - Phone:864-654-0322
Mailing Address - Fax:864-654-0324
Practice Address - Street 1:1011 TIGER BLVD
Practice Address - Street 2:SUITE 610
Practice Address - City:CLEMSON
Practice Address - State:SC
Practice Address - Zip Code:29631-2915
Practice Address - Country:US
Practice Address - Phone:864-654-0322
Practice Address - Fax:864-654-0324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4325101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty