Provider Demographics
NPI:1417234394
Name:ESSENTIAL BEHAVIOR COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:ESSENTIAL BEHAVIOR COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO CEO/ CO CEO
Authorized Official - Prefix:
Authorized Official - First Name:HOPE/GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:GAINES/EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-290-6860
Mailing Address - Street 1:2344 NORTHVIEW DR
Mailing Address - Street 2:APT 3E
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29118-2973
Mailing Address - Country:US
Mailing Address - Phone:803-290-6860
Mailing Address - Fax:
Practice Address - Street 1:131 POPLAR STREET
Practice Address - Street 2:ROOM 114
Practice Address - City:BOWMAN
Practice Address - State:SC
Practice Address - Zip Code:29018
Practice Address - Country:US
Practice Address - Phone:803-290-6860
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-07
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty