Healthcare Provider Details

I. General information

NPI: 1093638199
Provider Name (Legal Business Name): COUNSELING SERVICES OF SC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 E MAIN ST
ROCK HILL SC
29730
US

IV. Provider business mailing address

512 POND VIEW LN
RICHBURG SC
29729-0090
US

V. Phone/Fax

Practice location:
  • Phone: 803-288-0051
  • Fax:
Mailing address:
  • Phone: 803-322-7880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY CANNON
Title or Position: LCSW/OWNER
Credential: LCSW
Phone: 803-288-0051