Healthcare Provider Details

I. General information

NPI: 1063135648
Provider Name (Legal Business Name): PARK CIRCLE COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2022
Last Update Date: 10/19/2022
Certification Date: 10/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6296 RIVERS AVENUE
NORTH CHARLESTON SC
29406
US

IV. Provider business mailing address

P.O. BOX 21806
CHARLESTON SC
29413
US

V. Phone/Fax

Practice location:
  • Phone: 843-732-0007
  • Fax:
Mailing address:
  • Phone: 843-732-0007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. SARAH M. HARBIN
Title or Position: OWNER/THERAPIST
Credential: LPC
Phone: 843-732-0007