Healthcare Provider Details

I. General information

NPI: 1144109190
Provider Name (Legal Business Name): BREATHE LIFE COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2025
Last Update Date: 09/02/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1495 REMOUNT RD STE 3A
NORTH CHARLESTON SC
29406-3320
US

IV. Provider business mailing address

1495 REMOUNT RD STE 3A
NORTH CHARLESTON SC
29406-3320
US

V. Phone/Fax

Practice location:
  • Phone: 843-882-6880
  • Fax: 843-892-0394
Mailing address:
  • Phone: 843-882-6880
  • Fax: 843-892-0394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: KATHERINE GROSS
Title or Position: PRACTICE CO-OWNER
Credential: MA, LPCS, CFMHE, NCC
Phone: 843-882-6880