Healthcare Provider Details

I. General information

NPI: 1972941003
Provider Name (Legal Business Name): VISION COUNSELING & VOCATIONAL CONSULTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2013
Last Update Date: 06/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9367 TWO NOTCH RD SUITE F-1
COLUMBIA SC
29223-6442
US

IV. Provider business mailing address

9367 TWO NOTCH RD SUITE F-1
COLUMBIA SC
29223-6442
US

V. Phone/Fax

Practice location:
  • Phone: 803-563-5087
  • Fax:
Mailing address:
  • Phone: 803-563-5087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number#5466
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number9472
License Number StateSC

VIII. Authorized Official

Name: CHADDRICK LANEIR MIDDLETON
Title or Position: OWNER
Credential: CRC, CVE, LPC-I
Phone: 803-563-5087