Provider Demographics
NPI:1982768735
Name:KOESTLINE, WILLIAM CHARLES JR (MA)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:CHARLES
Last Name:KOESTLINE
Suffix:JR
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1509 QUAIL VLY W
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29212-1536
Mailing Address - Country:US
Mailing Address - Phone:803-781-1565
Mailing Address - Fax:
Practice Address - Street 1:6952 SAINT ANDREWS RD
Practice Address - Street 2:ST. ANDREWS PRESBYTERIAN CHURCH
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29212-1143
Practice Address - Country:US
Practice Address - Phone:803-732-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC149101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional