Healthcare Provider Details

I. General information

NPI: 1598669962
Provider Name (Legal Business Name): THE BEACON COUNSELING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 N MATSON ST
KERSHAW SC
29067-1218
US

IV. Provider business mailing address

PO BOX 56
KERSHAW SC
29067-0056
US

V. Phone/Fax

Practice location:
  • Phone: 503-577-7631
  • Fax:
Mailing address:
  • Phone: 803-577-7631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: SCOTT THOMAS WHALEY
Title or Position: OFFICER
Credential:
Phone: 803-577-7628