Provider Demographics
NPI:1255030862
Name:AGAPE COUNSELING AND HEALING CENTER
Entity type:Organization
Organization Name:AGAPE COUNSELING AND HEALING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:VITACOLONNA
Authorized Official - Suffix:
Authorized Official - Credentials:MS LPC
Authorized Official - Phone:360-349-8775
Mailing Address - Street 1:657 S COIT ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-5256
Mailing Address - Country:US
Mailing Address - Phone:843-799-8611
Mailing Address - Fax:
Practice Address - Street 1:657 S COIT ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-5256
Practice Address - Country:US
Practice Address - Phone:843-799-8611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-02
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC8246OtherSOUTH CAROLINA LICENSING BOARD FOR COUNSELORS