Healthcare Provider Details

I. General information

NPI: 1073987210
Provider Name (Legal Business Name): COUNSELING SUMTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2015
Last Update Date: 01/25/2021
Certification Date: 01/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2645A HARDEE CV
SUMTER SC
29150
US

IV. Provider business mailing address

2645A HARDEE CV
SUMTER SC
29150-1893
US

V. Phone/Fax

Practice location:
  • Phone: 803-720-9465
  • Fax: 803-526-7067
Mailing address:
  • Phone: 803-720-9465
  • Fax: 803-526-7067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9522
License Number StateSC

VIII. Authorized Official

Name: MRS. GAYLA PARTIN
Title or Position: OWNER/COUNSELOR
Credential: LISW-CP
Phone: 803-720-9465