Healthcare Provider Details

I. General information

NPI: 1992616247
Provider Name (Legal Business Name): BOUND & BALANCED, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 OLD TROLLEY RD
SUMMERVILLE SC
29485-8283
US

IV. Provider business mailing address

202 TRESTLEWOOD DR
SUMMERVILLE SC
29486-1824
US

V. Phone/Fax

Practice location:
  • Phone: 843-781-0075
  • Fax:
Mailing address:
  • Phone: 810-434-1085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. EMILEE RAE LAENEN
Title or Position: PRACTICE OWNER
Credential: LPCA
Phone: 810-434-1085