Provider Demographics
NPI:1467665265
Name:EASTSIDE COUNSELING SERVICE
Entity Type:Organization
Organization Name:EASTSIDE COUNSELING SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MADORA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LISW-CP
Authorized Official - Phone:864-298-8026
Mailing Address - Street 1:110 MANLY ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-3025
Mailing Address - Country:US
Mailing Address - Phone:864-298-8026
Mailing Address - Fax:864-298-8032
Practice Address - Street 1:110 MANLY ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-3025
Practice Address - Country:US
Practice Address - Phone:864-298-8026
Practice Address - Fax:864-298-8032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health