Healthcare Provider Details

I. General information

NPI: 1609277896
Provider Name (Legal Business Name): WOTP COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2014
Last Update Date: 09/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 HOLYWOODS RD
KINGSTREE SC
29556-6200
US

IV. Provider business mailing address

36 HOLYWOODS RD
KINGSTREE SC
29556-6200
US

V. Phone/Fax

Practice location:
  • Phone: 832-259-9852
  • Fax:
Mailing address:
  • Phone: 832-259-9852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MISS KESHA BARRINGTON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 832-259-9852