Provider Demographics
NPI:1447571237
Name:LOOKING GLASS BEHAVIORAL HEALTH ASSOCIATES LLC
Entity Type:Organization
Organization Name:LOOKING GLASS BEHAVIORAL HEALTH ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:FREDRICK
Authorized Official - Last Name:AYERS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:843-676-9966
Mailing Address - Street 1:656 S COIT ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-5255
Mailing Address - Country:US
Mailing Address - Phone:843-676-9966
Mailing Address - Fax:843-661-5055
Practice Address - Street 1:656 S COIT ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-5255
Practice Address - Country:US
Practice Address - Phone:843-676-9966
Practice Address - Fax:843-661-5055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-16
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2460101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty