Provider Demographics
NPI:1356005664
Name:COUCH WITH CHRISTIAN, LLC
Entity Type:Organization
Organization Name:COUCH WITH CHRISTIAN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHARAYAH
Authorized Official - Middle Name:CHRISTIAN
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LPC/S, NCC
Authorized Official - Phone:803-727-2479
Mailing Address - Street 1:78 HUNTERS POND DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-9009
Mailing Address - Country:US
Mailing Address - Phone:803-727-2479
Mailing Address - Fax:
Practice Address - Street 1:1403 CALHOUN ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2509
Practice Address - Country:US
Practice Address - Phone:803-727-2479
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-25
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty