Healthcare Provider Details

I. General information

NPI: 1912952904
Provider Name (Legal Business Name): COUNSELING CENTER OF CHARLESTON INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1041 JOHNNIE DODDS BLVD STE 5C
MT PLEASANT SC
29464-6156
US

IV. Provider business mailing address

1041 JOHNNIE DODDS BLVD STE 5C
MT PLEASANT SC
29464-6156
US

V. Phone/Fax

Practice location:
  • Phone: 843-856-8975
  • Fax: 843-856-8994
Mailing address:
  • Phone: 843-856-8975
  • Fax: 843-856-8994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2395
License Number StateSC

VIII. Authorized Official

Name: MR. PRUE MCGEE HAMMETT JR.
Title or Position: OWNER
Credential: M DIV
Phone: 843-856-8975