Provider Demographics
NPI:1922631522
Name:OCEANIC COUNSELING GROUP LLC
Entity Type:Organization
Organization Name:OCEANIC COUNSELING GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KENZA
Authorized Official - Middle Name:GRACE
Authorized Official - Last Name:HADDOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:843-855-6051
Mailing Address - Street 1:PO BOX 16091
Mailing Address - Street 2:
Mailing Address - City:SURFSIDE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29587-6091
Mailing Address - Country:US
Mailing Address - Phone:843-267-4690
Mailing Address - Fax:
Practice Address - Street 1:215 RONNIE CT STE C
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29579-4204
Practice Address - Country:US
Practice Address - Phone:843-894-0000
Practice Address - Fax:843-589-9054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-21
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty