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General NPI Number Information
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NPI Number | 1083144125
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Entity Type | Organization
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Legal Business Name | RADICAL TRANSFORMATIONS COUNSELING SERVICES LLC
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Dates
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Enumeration Date | 06/12/2017
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 630 OLD ORANGEBURG RD APT A
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City | LEXINGTON
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State | SC
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Zip | 29073-6927
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Country | US
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Telephone | 803-727-0658
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 8781
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City | COLUMBIA
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State | SC
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Zip | 29202-8781
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Country | US
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Telephone | 803-727-0658
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Fax |
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Authorized Official
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Title or Position | CLINCIAL COUNSELOR
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Name | DEANA LENETTE TUCKER
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Credential | MA,CACII, LPC,MAC
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Telephone | 803-727-0658
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 6111
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License Number State | SC
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