Provider Demographics
NPI:1235527326
Name:COUNSELING CENTER OF PENDELTON
Entity Type:Organization
Organization Name:COUNSELING CENTER OF PENDELTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:GOFF
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:864-812-9400
Mailing Address - Street 1:104 BROWNS SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:WALHALLA
Mailing Address - State:SC
Mailing Address - Zip Code:29691-2271
Mailing Address - Country:US
Mailing Address - Phone:864-812-9400
Mailing Address - Fax:864-644-2710
Practice Address - Street 1:104 BROWNS SQUARE DR
Practice Address - Street 2:
Practice Address - City:WALHALLA
Practice Address - State:SC
Practice Address - Zip Code:29691-2271
Practice Address - Country:US
Practice Address - Phone:864-812-9400
Practice Address - Fax:864-644-2710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-26
Last Update Date:2014-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4637101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC4637OtherSC LICENSES NUMBER