Provider Demographics
NPI:1932144722
Name:SG PSYCHOTHERAPY AND COUNSELING ASSOCIATES, LLC
Entity Type:Organization
Organization Name:SG PSYCHOTHERAPY AND COUNSELING ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER/OWN
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:F
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LISW-CP
Authorized Official - Phone:803-939-9699
Mailing Address - Street 1:207 HAMPTONS GRANT CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29209-1973
Mailing Address - Country:US
Mailing Address - Phone:803-783-6560
Mailing Address - Fax:
Practice Address - Street 1:2999 SUNSET BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-3496
Practice Address - Country:US
Practice Address - Phone:803-939-9699
Practice Address - Fax:803-939-9086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC69611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC8175Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER