Provider Demographics
NPI:1992847248
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:2007-02-13
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC36641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC29260P001OtherPLANNED ADMINISTRATORS
NE68131M001OtherMUTUAL OF OMAHA
SC29219B001OtherBCBS OF SC
PA17089H001OtherHIGHMARK, INC
SC29219T001OtherTRICARE FOR LIFE
SC00880Medicare ID - Type Unspecified