Provider Demographics
NPI:1497237101
Name:GINNY PAGE COUNSELING, LLC
Entity Type:Organization
Organization Name:GINNY PAGE COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:VIRGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:PAGE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:843-267-8885
Mailing Address - Street 1:314 72ND AVE N
Mailing Address - Street 2:UINIT #A
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29572-3810
Mailing Address - Country:US
Mailing Address - Phone:843-267-8885
Mailing Address - Fax:
Practice Address - Street 1:1203 48TH AVENUE NORTH
Practice Address - Street 2:SUITE 202
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-5425
Practice Address - Country:US
Practice Address - Phone:843-267-8885
Practice Address - Fax:843-449-5861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5658101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty