Provider Demographics
NPI:1013351105
Name:PLUFF MUD COUNSELING LLC
Entity Type:Organization
Organization Name:PLUFF MUD COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:T
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MAMFT
Authorized Official - Phone:843-259-0591
Mailing Address - Street 1:3012 ALLISON COVE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-4971
Mailing Address - Country:US
Mailing Address - Phone:843-259-0591
Mailing Address - Fax:843-769-7288
Practice Address - Street 1:896 KUSHIWAH CREEK DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-4410
Practice Address - Country:US
Practice Address - Phone:843-259-0591
Practice Address - Fax:843-769-7288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-19
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty