Provider Demographics
NPI:1235453549
Name:2C-CLEARLY CORP.
Entity Type:Organization
Organization Name:2C-CLEARLY CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:DELORES
Authorized Official - Middle Name:G
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:843-222-4599
Mailing Address - Street 1:250 ELM ST
Mailing Address - Street 2:#807
Mailing Address - City:CLEMSON
Mailing Address - State:SC
Mailing Address - Zip Code:29631-1025
Mailing Address - Country:US
Mailing Address - Phone:864-643-0592
Mailing Address - Fax:864-643-0594
Practice Address - Street 1:920 MOUNT GILEAD RD
Practice Address - Street 2:BLDG. C, STE.3
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-7791
Practice Address - Country:US
Practice Address - Phone:843-222-4599
Practice Address - Fax:864-643-0594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-16
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2833101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty