Healthcare Provider Details

I. General information

NPI: 1992638043
Provider Name (Legal Business Name): UPSTATE COUNSELING & CONSULTING LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 W MAIN ST
WALHALLA SC
29691-1929
US

IV. Provider business mailing address

512 ALRAD DR
WALHALLA SC
29691-1882
US

V. Phone/Fax

Practice location:
  • Phone: 865-696-0678
  • Fax:
Mailing address:
  • Phone: 865-696-0678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES POLK COOLEY III
Title or Position: OWNER/CLINICIAN
Credential: LISW-CP
Phone: 865-696-0678