Healthcare Provider Details

I. General information

NPI: 1316375678
Provider Name (Legal Business Name): CHARLESTON COUNSELING CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2013
Last Update Date: 10/05/2023
Certification Date: 10/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

871 LOWCOUNTRY BLVD STE 200
MOUNT PLEASANT SC
29464
US

IV. Provider business mailing address

871 LOWCOUNTRY BLVD STE 200
MOUNT PLEASANT SC
29464-3096
US

V. Phone/Fax

Practice location:
  • Phone: 843-501-1099
  • Fax:
Mailing address:
  • Phone: 843-501-1099
  • 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 Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8539
License Number StateSC
# 4
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: RYAN PARDO
Title or Position: CHIEF LEGAL OFFICER
Credential:
Phone: 425-279-8500