Healthcare Provider Details

I. General information

NPI: 1588246763
Provider Name (Legal Business Name): CAROLINA COUNSELING ASSOCIATES OF THE UPSTATE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2021
Last Update Date: 04/27/2021
Certification Date: 04/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 PLAZA CIR STE C
CLINTON SC
29325-7560
US

IV. Provider business mailing address

10 FOWLER OAKS LN
SIMPSONVILLE SC
29681-4092
US

V. Phone/Fax

Practice location:
  • Phone: 864-399-4425
  • Fax:
Mailing address:
  • Phone: 864-399-4425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: CHARITY KILGORE
Title or Position: OWNER
Credential: LPC
Phone: 864-399-4425