Provider Demographics
NPI:1568858165
Name:YOUR COUNSELING SERVICES INC
Entity Type:Organization
Organization Name:YOUR COUNSELING SERVICES INC
Other - Org Name:YOUR COUNSELING SERVICES INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:KEM
Authorized Official - Middle Name:D
Authorized Official - Last Name:FRAISER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:843-260-5361
Mailing Address - Street 1:6650 RIVERS AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-4809
Mailing Address - Country:US
Mailing Address - Phone:843-260-5361
Mailing Address - Fax:
Practice Address - Street 1:6650 RIVERS AVE
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-4809
Practice Address - Country:US
Practice Address - Phone:843-260-5361
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC101YM0800X, 103K00000X
SCHA1007251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCHA1007Medicaid
NC0835902OtherARTICLES OF INCORPORATION
11850682OtherCAQH PROVIDER ID
GA638940225BMedicaid
11850682OtherCAQH PROVIDER ID