MEDICARE: PROVISIONS COUNSELING 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	251S00000X	Community/Behavioral Health Agency	1484	NC
2	251S00000X	Community/Behavioral Health Agency	4611	SC

General Provider Information

NPI Number	:	1811371842
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROVISIONS COUNSELING SERVICES LLC

Provider Business Mailing Address
First Line	:	5115 MINTVALE DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28269-1689
Country	:	US
Telephone Number	:	704-906-5558
Fax Number	:

Provider Business Practice Location Address
First Line	:	6 EXECUTIVE CT
Second Line	:
City	:	LAKE WYLIE
State	:	SC
Zip	:	29710-9338
Country	:	US
Telephone Number	:	704-906-5558
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	SHIRICKA LASHAYE FAIR
Credential	:	LMFT
Telephone Number	:	704-906-5558

Provider Enumeration Date	:	07/20/2015
Last Update Date	:	07/20/2015

Similar Medicare Providers

1740419894 — PRESTIGE HOME HEALTH
Practice Location Address:

6 EXECUTIVE CT
LAKE WYLIE, SC
29710-9338

Practice Phone: 803-831-6778
Practice Fax:

1285863324 — PRESTIGE DIABETIC SUPPLIES
Practice Location Address:

6 EXECUTIVE CT
LAKE WYLIE, SC
29710-9338

Practice Phone: 803-831-6778
Practice Fax:

1649599747 — MRS. SHERITA FEATHERSTONE DAVIS MED, LPC
Practice Location Address:

9 EXECUTIVE COURT , SUITE 103
LAKE WYLIE, SC
29710-9338

Practice Phone: 803-265-8343
Practice Fax:

1790025153 — CHRISTINE ALLEN LPC-I
Practice Location Address:

12 EXECUTIVE CT
LAKE WYLIE, SC
29710-9338

Practice Phone: 803-295-0005
Practice Fax:

1003218371 — COMPANION COUNSELING AND COACHING
Practice Location Address:

9 EXECUTIVE COURT , SUITE #103
LAKE WYLIE, SC
29710-9338

Practice Phone: 803-265-8343
Practice Fax: 803-526-7635

1164454609 — DR. NAZILA ESHRAGHI DPM
Practice Location Address:

5 EXECUTIVE CT # 102
CLOVER, SC
29710-9338

Practice Phone: 803-693-2425
Practice Fax: 833-989-2166

Directions to “PROVISIONS COUNSELING SERVICES LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.