Healthcare Provider Details

I. General information

NPI: 1083777916
Provider Name (Legal Business Name): PETTIGRU COUNSELING ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 PETTIGRU ST
GREENVILLE SC
29601-3114
US

IV. Provider business mailing address

405 PETTIGRU ST
GREENVILLE SC
29601-3114
US

V. Phone/Fax

Practice location:
  • Phone: 864-271-3549
  • Fax: 864-271-8282
Mailing address:
  • Phone: 864-271-3549
  • Fax: 864-271-8282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. CINDY MARKS
Title or Position: TREASURER
Credential: PH.D.
Phone: 864-271-3549