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General NPI Number Information
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NPI Number | 1053095083
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Entity Type | Organization
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Legal Business Name | STEADFAST CHRISTIAN COUNSELING, LLC
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Dates
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Enumeration Date | 06/12/2023
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Last Update Date | 06/12/2023
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Provider Practice Location Address
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Address Line | 21 GAMECOCK AVE
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City | CHARLESTON
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State | SC
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Zip | 29407-3368
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Country | US
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Telephone | 843-417-0817
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Fax | 843-936-4830
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Provider Business Mailing Address
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Address Line | 21 GAMECOCK AVE STE E
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City | CHARLESTON
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State | SC
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Zip | 29407-3368
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Country | US
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Telephone | 843-417-0817
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Fax | 843-936-4830
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Authorized Official
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Title or Position | OWNER
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Name | JESSICA EVANS
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Credential | LPC
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Telephone | 843-417-0817
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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