Provider Demographics
NPI:1356991467
Name:CAROLINA COUNSELING ASSOCIATES SC, LLC
Entity type:Organization
Organization Name:CAROLINA COUNSELING ASSOCIATES SC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:COOKE
Authorized Official - Last Name:BRANHAM
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:803-772-7776
Mailing Address - Street 1:422 CREEK BRANCH CT
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-6627
Mailing Address - Country:US
Mailing Address - Phone:803-772-7776
Mailing Address - Fax:
Practice Address - Street 1:9 CLUSTERS CT STE A
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-4862
Practice Address - Country:US
Practice Address - Phone:803-772-7776
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-19
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty