Healthcare Provider Details

I. General information

NPI: 1346974383
Provider Name (Legal Business Name): HIGH HOPES MENTAL WELLNESS ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2022
Last Update Date: 11/10/2022
Certification Date: 11/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

989 KNOX ABBOTT DR STE 112
CAYCE SC
29033-3346
US

IV. Provider business mailing address

3970 CAESARS RD
WEST COLUMBIA SC
29170-1312
US

V. Phone/Fax

Practice location:
  • Phone: 803-828-0775
  • Fax: 803-756-2550
Mailing address:
  • Phone: 803-530-3564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES STEWART COURTNEY
Title or Position: OWNER, PRESIDENT
Credential: LPC
Phone: 803-530-3564