MEDICARE: ONE ACCORD COUNSELING, 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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1467112060
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ONE ACCORD COUNSELING, LLC

Provider Business Mailing Address
First Line	:	143 KELSNEY RIDGE DR
Second Line	:
City	:	ELGIN
State	:	SC
Zip	:	29045-8396
Country	:	US
Telephone Number	:	803-920-9512
Fax Number	:	803-759-8423

Provider Business Practice Location Address
First Line	:	143 KELSNEY RIDGE DR
Second Line	:
City	:	ELGIN
State	:	SC
Zip	:	29045-8396
Country	:	US
Telephone Number	:	803-920-9512
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING OFFICER
Name	:	TAMMY PERIAN
Credential	:
Telephone Number	:	803-399-8083

Provider Enumeration Date	:	12/22/2021
Last Update Date	:	12/22/2021

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