Provider Demographics
NPI:1356906499
Name:LIVE LEARN HOPE INDIVIDUAL AND FAMILY COUNSELING
Entity type:Organization
Organization Name:LIVE LEARN HOPE INDIVIDUAL AND FAMILY COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FALLON
Authorized Official - Middle Name:NOEL
Authorized Official - Last Name:SIMS
Authorized Official - Suffix:
Authorized Official - Credentials:LISW-CP
Authorized Official - Phone:803-843-5593
Mailing Address - Street 1:PO BOX 1181
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29202-1181
Mailing Address - Country:US
Mailing Address - Phone:803-834-5593
Mailing Address - Fax:803-526-7659
Practice Address - Street 1:1101 BELLEVIEW ST STE 104
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-1863
Practice Address - Country:US
Practice Address - Phone:803-834-5593
Practice Address - Fax:803-526-7659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-03
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty