Healthcare Provider Details

I. General information

NPI: 1194112920
Provider Name (Legal Business Name): A PIECE OF MIND COUNSELING AND CONSULTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2015
Last Update Date: 04/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3944 HIGHWAY 17 UNIT 7
MURRELLS INLET SC
29576-5094
US

IV. Provider business mailing address

3944 HIGHWAY 17 UNIT 7
MURRELLS INLET SC
29576-5094
US

V. Phone/Fax

Practice location:
  • Phone: 843-318-0380
  • Fax: 843-947-0812
Mailing address:
  • Phone: 843-318-0380
  • Fax: 843-947-0812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3958
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4342
License Number StateSC

VIII. Authorized Official

Name: AMY N CANTLEY
Title or Position: OWNER/LICENSED PROF. COUNSELOR
Credential: LPC,CFC,BCPC,DAPA
Phone: 843-318-0380