Provider Demographics
NPI:1972620193
Name:CANTERBURY COUNSELING CENTER
Entity Type:Organization
Organization Name:CANTERBURY COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARION
Authorized Official - Middle Name:B
Authorized Official - Last Name:CROOKS
Authorized Official - Suffix:JR
Authorized Official - Credentials:LISW-CP
Authorized Official - Phone:864-235-7501
Mailing Address - Street 1:7 PETTIGRU ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-3000
Mailing Address - Country:US
Mailing Address - Phone:864-235-7501
Mailing Address - Fax:864-235-7503
Practice Address - Street 1:7 PETTIGRU ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-3000
Practice Address - Country:US
Practice Address - Phone:864-235-7501
Practice Address - Fax:864-235-7503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC36641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC=========OtherBLUE CHOICE
TN=========OtherCIGNA HEALTHCARE
MD=========OtherAPS
MN=========OtherCIGNA
FL=========OtherMHNET
NE=========OtherHEALTH CARE SAVINGS
UT=========OtherUNITED BEHAVIORAL HEALTH
IL=========OtherCOMPSYCH
SC=========OtherCOMPANION
PA=========OtherCIGNA HEALTHCARE
GA=========OtherUNITED HEALTHCARE
TX=========OtherAETNA
SC=========OtherBLUE CROSS BLUE SHIELD
SC=========OtherPLANNED ADMINISTRTORS
SC=========OtherTRICARE PGBA
SC=========OtherCOMPANION