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General NPI Number Information
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NPI Number | 1073054847
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Entity Type | Organization
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Legal Business Name | COLUMBIA NORTHEAST COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 03/13/2017
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Last Update Date | 03/13/2017
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Provider Practice Location Address
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Address Line | 9570 TWO NOTCH RD SUITE #8
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City | COLUMBIA
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State | SC
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Zip | 29223-4308
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Country | US
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Telephone | 803-782-5556
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Fax | 803-788-0914
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Provider Business Mailing Address
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Address Line | PO BOX 25453
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City | COLUMBIA
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State | SC
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Zip | 29224-5453
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Country | US
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Telephone | 803-782-5556
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Fax | 803-788-0914
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Authorized Official
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Title or Position | OWNER/MENTAL HEALTH COUNSELOR
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Name | SUZANNE W PEEBLES
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Credential | M.ED, LPC
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Telephone | 803-782-5556
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 8950
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 3157
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License Number State | SC
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