Healthcare Provider Details

I. General information

NPI: 1023604964
Provider Name (Legal Business Name): FOUNDATIONS COUNSELING AND WELLNESS CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2020
Last Update Date: 12/15/2020
Certification Date: 12/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 CENTRAL AVE STE 18100-B
GOOSE CREEK SC
29445-3084
US

IV. Provider business mailing address

105 CENTRAL AVE STE 18100-B
GOOSE CREEK SC
29445-3084
US

V. Phone/Fax

Practice location:
  • Phone: 854-588-5710
  • Fax: 843-429-8998
Mailing address:
  • Phone: 854-588-5710
  • Fax: 843-429-8998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MRS. ALICIA RUTH ZORN
Title or Position: OWNER/THERAPIST
Credential: LISW-CP
Phone: 843-588-5710