Healthcare Provider Details

I. General information

NPI: 1821193418
Provider Name (Legal Business Name): LEXINGTON BAPTIST CHURCH COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 09/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 E MAIN ST
LEXINGTON SC
29072-3546
US

IV. Provider business mailing address

224 E MAIN ST
LEXINGTON SC
29072-3546
US

V. Phone/Fax

Practice location:
  • Phone: 803-808-5222
  • Fax: 803-957-2062
Mailing address:
  • Phone: 803-808-5222
  • Fax: 803-957-2062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateSC

VIII. Authorized Official

Name: MRS. ROBIN F TEMPLES
Title or Position: DIRECTOR
Credential: LMFT, LPES
Phone: 803-808-5222