Healthcare Provider Details

I. General information

NPI: 1083170948
Provider Name (Legal Business Name): COUCH AND ANDERSON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2019
Last Update Date: 02/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3E CLEVELAND CT
GREENVILLE SC
29607-2414
US

IV. Provider business mailing address

372 DOBSON RD
DUNCAN SC
29334-9758
US

V. Phone/Fax

Practice location:
  • Phone: 864-304-9496
  • Fax:
Mailing address:
  • Phone: 864-415-2554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: CHRYSTAL ANDERSON
Title or Position: OWNER
Credential: LPC
Phone: 864-415-2554