Provider Demographics
NPI:1356558019
Name:A CENTER FOR ADULT ADOLESCENT & CHILD COUNSELING PA
Entity type:Organization
Organization Name:A CENTER FOR ADULT ADOLESCENT & CHILD COUNSELING PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR & PSYCHOTHERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:BILLY
Authorized Official - Middle Name:ENGRAM
Authorized Official - Last Name:BARRINEAU
Authorized Official - Suffix:
Authorized Official - Credentials:MS LPC LMSW
Authorized Official - Phone:843-763-0363
Mailing Address - Street 1:1112 OLD TOWNE RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-6063
Mailing Address - Country:US
Mailing Address - Phone:843-763-0363
Mailing Address - Fax:843-763-0363
Practice Address - Street 1:1112 OLD TOWNE RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-6063
Practice Address - Country:US
Practice Address - Phone:843-763-0363
Practice Address - Fax:843-763-0363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC103101YP2500X
SC806104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ310010281Medicare ID - Type Unspecified