Provider Demographics
NPI:1891186524
Name:CHOSEN COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:CHOSEN COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:OBIKA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:706-284-1464
Mailing Address - Street 1:31 BARNETTE DR
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-8003
Mailing Address - Country:US
Mailing Address - Phone:706-284-1464
Mailing Address - Fax:
Practice Address - Street 1:18 BARNETTE DR
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-8004
Practice Address - Country:US
Practice Address - Phone:706-284-1464
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-17
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5095251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1033169834Medicaid