MEDICARE: OCEANIC COUNSELING GROUP 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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1922631522
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OCEANIC COUNSELING GROUP LLC

Provider Business Mailing Address
First Line	:	PO BOX 16091
Second Line	:
City	:	SURFSIDE BEACH
State	:	SC
Zip	:	29587-6091
Country	:	US
Telephone Number	:	843-267-4690
Fax Number	:

Provider Business Practice Location Address
First Line	:	215 RONNIE CT STE C
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-4204
Country	:	US
Telephone Number	:	843-894-0000
Fax Number	:	843-589-9054

Authorized Official
Title or Position	:	COUNSELOR
Name	:	MRS. KENZA GRACE HADDOCK
Credential	:	M.A
Telephone Number	:	843-855-6051

Provider Enumeration Date	:	02/21/2020
Last Update Date	:	12/04/2025

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