Provider Demographics
NPI:1245644020
Name:CHARIS CHRISTIAN COUNSELING CENTER, INC
Entity type:Organization
Organization Name:CHARIS CHRISTIAN COUNSELING CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:BASIE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:803-493-7272
Mailing Address - Street 1:1525 BAYBERRY PL
Mailing Address - Street 2:
Mailing Address - City:CLOVER
Mailing Address - State:SC
Mailing Address - Zip Code:29710-8548
Mailing Address - Country:US
Mailing Address - Phone:803-493-7272
Mailing Address - Fax:
Practice Address - Street 1:1190 GOLD HILL RD
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-8977
Practice Address - Country:US
Practice Address - Phone:803-493-7272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-19
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4675251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health