Provider Demographics
NPI:1265489793
Name:THE CENTER FOR COUNSELING AND LIFE SKILL DEVELOPMENT
Entity Type:Organization
Organization Name:THE CENTER FOR COUNSELING AND LIFE SKILL DEVELOPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CLINICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TARA
Authorized Official - Middle Name:WEST
Authorized Official - Last Name:HORNE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:864-457-4208
Mailing Address - Street 1:1012 S BLACKSTOCK RD
Mailing Address - Street 2:
Mailing Address - City:LANDRUM
Mailing Address - State:SC
Mailing Address - Zip Code:29356-9136
Mailing Address - Country:US
Mailing Address - Phone:864-457-4208
Mailing Address - Fax:864-457-2866
Practice Address - Street 1:1012 S BLACKSTOCK RD
Practice Address - Street 2:
Practice Address - City:LANDRUM
Practice Address - State:SC
Practice Address - Zip Code:29356-9136
Practice Address - Country:US
Practice Address - Phone:864-457-4208
Practice Address - Fax:864-457-2866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-29
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLPC 3338101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty