Healthcare Provider Details

I. General information

NPI: 1497237101
Provider Name (Legal Business Name): GINNY PAGE COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2018
Last Update Date: 08/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1203 48TH AVENUE NORTH SUITE 202
MYRTLE BEACH SC
29577-5425
US

IV. Provider business mailing address

314 72ND AVE N UINIT #A
MYRTLE BEACH SC
29572-3810
US

V. Phone/Fax

Practice location:
  • Phone: 843-267-8885
  • Fax: 843-449-5861
Mailing address:
  • Phone: 843-267-8885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5658
License Number StateSC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: VIRGINA PAGE
Title or Position: SOLE PROPRIETOR
Credential: LPC
Phone: 843-267-8885