Healthcare Provider Details

I. General information

NPI: 1588491385
Provider Name (Legal Business Name): FOUNDATIONS COUNSELING BEHAVIORAL AGENCY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2024
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 SPRINGHALL DR UNIT B
GOOSE CREEK SC
29445-5351
US

IV. Provider business mailing address

111 SPRINGHALL DR UNIT B
GOOSE CREEK SC
29445-5351
US

V. Phone/Fax

Practice location:
  • Phone: 843-588-5710
  • Fax:
Mailing address:
  • Phone: 843-960-9293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ALICIA ZORN
Title or Position: OWNER
Credential:
Phone: 843-609-8685