Healthcare Provider Details

I. General information

NPI: 1114589223
Provider Name (Legal Business Name): SOTERIA COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2019
Last Update Date: 06/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 YELLOW ROSE CT
GREER SC
29651-9006
US

IV. Provider business mailing address

316 YELLOW ROSE CT
GREER SC
29651-9006
US

V. Phone/Fax

Practice location:
  • Phone: 864-409-7049
  • Fax:
Mailing address:
  • Phone: 864-704-7616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier10008
Identifier TypeMEDICAID
Identifier StateSC
Identifier Issuer

VIII. Authorized Official

Name: KATINA DENISE JONES
Title or Position: OWNER
Credential: LISW-CPS
Phone: 864-409-7049