Healthcare Provider Details

I. General information

NPI: 1679848840
Provider Name (Legal Business Name): GOINES COUNSELING AND CONSULTING SERVICES,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2012
Last Update Date: 03/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2625 RUTLEDGE RD
COLUMBIA SC
29204
US

IV. Provider business mailing address

2625 RUTLEDGE RD
COLUMBIA SC
29204
US

V. Phone/Fax

Practice location:
  • Phone: 803-542-7492
  • Fax: 803-799-1136
Mailing address:
  • Phone: 803-542-7492
  • Fax: 803-799-1136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4799
License Number StateSC

VIII. Authorized Official

Name: WILLIE GOINES
Title or Position: OWNER
Credential:
Phone: 803-240-4461