Healthcare Provider Details

I. General information

NPI: 1407133770
Provider Name (Legal Business Name): MT. HEBRON COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2011
Last Update Date: 11/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3050 LEAPHART RD
WEST COLUMBIA SC
29169-3000
US

IV. Provider business mailing address

3050 LEAPHART RD
WEST COLUMBIA SC
29169-3000
US

V. Phone/Fax

Practice location:
  • Phone: 803-791-0495
  • Fax: 803-791-1958
Mailing address:
  • Phone: 803-791-0495
  • Fax: 803-791-1958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number2970
License Number StateSC

VIII. Authorized Official

Name: KENNETH BARWICK
Title or Position: DIRECTOR
Credential: LMFT
Phone: 803-791-0495