Provider Demographics
NPI:1417601980
Name:SACRED GROVE COUNSELING & HEALING SERVICES, LLC
Entity Type:Organization
Organization Name:SACRED GROVE COUNSELING & HEALING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WENNDY
Authorized Official - Middle Name:
Authorized Official - Last Name:DUPKOSKI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LPC-S, LPC, NCC
Authorized Official - Phone:803-210-7422
Mailing Address - Street 1:114 N CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-2808
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:114 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-2808
Practice Address - Country:US
Practice Address - Phone:803-210-7422
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-03
Last Update Date:2022-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health