Healthcare Provider Details

I. General information

NPI: 1164849782
Provider Name (Legal Business Name): EMERALD COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2014
Last Update Date: 03/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2575 LIN DO CT STE C
SUMTER SC
29150-1832
US

IV. Provider business mailing address

6550 TIPPERARY LN
WEDGEFIELD SC
29168-9370
US

V. Phone/Fax

Practice location:
  • Phone: 803-381-6033
  • Fax: 803-462-4848
Mailing address:
  • Phone: 803-381-6033
  • Fax: 803-462-4848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9631
License Number StateSC

VIII. Authorized Official

Name: CHRISTY T SLOCUM
Title or Position: OWNER
Credential: LISW-CP
Phone: 803-381-6033