Provider Demographics
NPI:1346984762
Name:UNMOORED COUNSELING COLLECTIVE, LLC
Entity Type:Organization
Organization Name:UNMOORED COUNSELING COLLECTIVE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/LICENSED PROFESSIONAL COUN
Authorized Official - Prefix:
Authorized Official - First Name:LIZBETH
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAFFEO
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:205-901-1713
Mailing Address - Street 1:101 N PINE ST STE 210
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29302-1604
Mailing Address - Country:US
Mailing Address - Phone:864-210-3115
Mailing Address - Fax:864-469-5688
Practice Address - Street 1:101 N PINE ST STE 210
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29302-1604
Practice Address - Country:US
Practice Address - Phone:864-210-3115
Practice Address - Fax:864-469-5688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-21
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPC1889Medicaid