Provider Demographics
NPI:1598532814
Name:LANDRIE H ETHREDGE PROFESSIONAL COUNSELING, LLC
Entity Type:Organization
Organization Name:LANDRIE H ETHREDGE PROFESSIONAL COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:LANDRIE
Authorized Official - Middle Name:H
Authorized Official - Last Name:ETHREDGE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:601-405-2118
Mailing Address - Street 1:125 WAPPOO CREEK DRIVE
Mailing Address - Street 2:BLDG E, STE 201A
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:125 WAPPOO CREEK DRIVE
Practice Address - Street 2:BLDG E, STE 201A
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412
Practice Address - Country:US
Practice Address - Phone:843-410-9046
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-06
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty