Provider Demographics
NPI:1790175024
Name:ADOLPHSON, PETER (LPC, NCC)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:ADOLPHSON
Suffix:
Gender:M
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1517 HAMPTON ST
Mailing Address - Street 2:SUITE G
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2924
Mailing Address - Country:US
Mailing Address - Phone:803-917-2923
Mailing Address - Fax:
Practice Address - Street 1:1517 HAMPTON ST
Practice Address - Street 2:SUITE G
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2924
Practice Address - Country:US
Practice Address - Phone:803-917-2923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-26
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6045101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor