Provider Demographics
NPI:1265208235
Name:STONEWALL COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:STONEWALL COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:TROUTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:803-240-8310
Mailing Address - Street 1:409 SADDLEBROOKE RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-7854
Mailing Address - Country:US
Mailing Address - Phone:803-240-8310
Mailing Address - Fax:803-526-7628
Practice Address - Street 1:409 SADDLEBROOKE RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-7854
Practice Address - Country:US
Practice Address - Phone:803-240-8310
Practice Address - Fax:803-526-7628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-30
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health