Provider Demographics
NPI:1235258393
Name:COUNSELING & CONSULTANT SERVICES LLC
Entity Type:Organization
Organization Name:COUNSELING & CONSULTANT SERVICES LLC
Other - Org Name:COUNSELING CONSULTANTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CORRIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:LISW-CP
Authorized Official - Phone:803-772-6540
Mailing Address - Street 1:3905 W BELTLINE BLVD
Mailing Address - Street 2:SUITE 15
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-1503
Mailing Address - Country:US
Mailing Address - Phone:803-422-3265
Mailing Address - Fax:803-988-1068
Practice Address - Street 1:3905 W BELTLINE BLVD
Practice Address - Street 2:SUITE 15
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-1503
Practice Address - Country:US
Practice Address - Phone:803-422-3265
Practice Address - Fax:803-988-1068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC62901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC8695Medicare PIN