Provider Demographics
NPI:1659529717
Name:MIDLANDS COUNSELING & CONSULTING CENTER , LLC
Entity Type:Organization
Organization Name:MIDLANDS COUNSELING & CONSULTING CENTER , LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:
Authorized Official - Last Name:PREZZY
Authorized Official - Suffix:
Authorized Official - Credentials:MASTERS ART
Authorized Official - Phone:803-799-0144
Mailing Address - Street 1:2611 FOREST DR STE 114A
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-2372
Mailing Address - Country:US
Mailing Address - Phone:803-799-0144
Mailing Address - Fax:803-799-1136
Practice Address - Street 1:2611 FOREST DR STE 114A
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-2372
Practice Address - Country:US
Practice Address - Phone:803-799-0144
Practice Address - Fax:803-799-1136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCWP9902103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental DisabilitiesGroup - Single Specialty