MEDICARE: COUNSELING & CONSULTANT SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	6290	SC

General Provider Information

NPI Number	:	1235258393
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNSELING & CONSULTANT SERVICES LLC

Provider Business Mailing Address
First Line	:	3905 W BELTLINE BLVD
Second Line	:	SUITE 15
City	:	COLUMBIA
State	:	SC
Zip	:	29204-1503
Country	:	US
Telephone Number	:	803-422-3265
Fax Number	:	803-988-1068

Provider Business Practice Location Address
First Line	:	3905 W BELTLINE BLVD
Second Line	:	SUITE 15
City	:	COLUMBIA
State	:	SC
Zip	:	29204-1503
Country	:	US
Telephone Number	:	803-422-3265
Fax Number	:	803-988-1068

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MISS JILL MARIE CORRIGAN
Credential	:	LISW-CP
Telephone Number	:	803-772-6540

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	12/08/2014

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