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General NPI Number Information
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NPI Number | 1144973017
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Entity Type | Organization
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Legal Business Name | NURTURING DIVERGENCE COUNSELING & WELLNESS LLC
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Dates
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Enumeration Date | 02/01/2022
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Last Update Date | 11/25/2022
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Provider Practice Location Address
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Address Line | 6650 RIVERS AVE SUITE 100, REGISTERED AGENT
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City | CHARLESTON
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State | SC
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Zip | 29406
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Country | US
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Telephone | 803-262-5132
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Fax |
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Provider Business Mailing Address
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Address Line | 4425 JEFFERSON DAVIS HWY UNIT 1592
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City | CLEARWATER
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State | SC
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Zip | 29822-2172
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Country | US
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Telephone | 803-262-5132
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MELINDA LEDLOW
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Credential | LPC, LCPC
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Telephone | 803-262-5132
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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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