Provider Demographics
NPI:1356956650
Name:ALIVE & WELL COUNSELING, LLC
Entity type:Organization
Organization Name:ALIVE & WELL COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER & CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:LISW-CP
Authorized Official - Phone:864-921-0744
Mailing Address - Street 1:4841 CHERRY BLOSSOM DR
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-8732
Mailing Address - Country:US
Mailing Address - Phone:864-921-0744
Mailing Address - Fax:
Practice Address - Street 1:753 JOHNNIE DODDS BLVD STE 100
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3054
Practice Address - Country:US
Practice Address - Phone:864-921-0744
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty