Healthcare Provider Details

I. General information

NPI: 1962839712
Provider Name (Legal Business Name): SYNERGY COUNSELING OF GREENWOOD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2013
Last Update Date: 10/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 MAXWELL AVE
GREENWOOD SC
29646-2641
US

IV. Provider business mailing address

128 MAXWELL AVE
GREENWOOD SC
29646-2641
US

V. Phone/Fax

Practice location:
  • Phone: 864-223-2243
  • Fax:
Mailing address:
  • Phone: 864-223-2243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4252
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8551
License Number StateSC

VIII. Authorized Official

Name: EARCELIA PAUL HILL
Title or Position: OWNER/PARTNER
Credential: LPC
Phone: 864-223-2243