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General NPI Number Information
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NPI Number | 1164969317
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Entity Type | Organization
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Legal Business Name | CAROLINA CENTER FOR COUNSELING & BEHAVIORAL INTERVENTIONS, LLC
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Dates
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Enumeration Date | 01/26/2017
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Last Update Date | 01/26/2017
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Provider Practice Location Address
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Address Line | 421 SE MAIN ST STE 201
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City | SIMPSONVILLE
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State | SC
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Zip | 29681-2694
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Country | US
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Telephone | 864-963-4028
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Fax | 864-963-5960
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Provider Business Mailing Address
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Address Line | 421 SE MAIN ST STE 201
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City | SIMPSONVILLE
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State | SC
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Zip | 29681-2694
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Country | US
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Telephone | 864-963-4028
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Fax | 864-963-5960
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Authorized Official
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Title or Position | OWNER
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Name | MR. RONALD HENRY REAMES
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Credential | LPC
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Telephone | 864-963-4028
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 4953
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License Number State | SC
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