Provider Demographics
NPI:1750346532
Name:EAGLE'S NEST COUNSELING, LLC
Entity type:Organization
Organization Name:EAGLE'S NEST COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:FAILE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:803-322-1383
Mailing Address - Street 1:PO BOX 37084
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-0518
Mailing Address - Country:US
Mailing Address - Phone:803-322-1383
Mailing Address - Fax:
Practice Address - Street 1:2025 EBENEZER RD
Practice Address - Street 2:K-5
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1062
Practice Address - Country:US
Practice Address - Phone:803-322-1383
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-17
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3522101YP2500X
SC3719101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102329Medicaid