Provider Demographics
NPI:1265491377
Name:REACH FAMILY COUNSELING SERVICES, PC
Entity Type:Organization
Organization Name:REACH FAMILY COUNSELING SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF SOCIAL SERVICES
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:NJUGUNA
Authorized Official - Last Name:NAGI
Authorized Official - Suffix:
Authorized Official - Credentials:LPCS, EDS, DMIN
Authorized Official - Phone:803-333-9923
Mailing Address - Street 1:PO BOX 658
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-0658
Mailing Address - Country:US
Mailing Address - Phone:803-333-9923
Mailing Address - Fax:803-333-9926
Practice Address - Street 1:7420 WILSON BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-3017
Practice Address - Country:US
Practice Address - Phone:803-333-9923
Practice Address - Fax:803-333-9926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-20
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2344101Y00000X, 101YP2500X
SC2517101YM0800X
101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCBT 017Medicaid