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General NPI Number Information
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NPI Number | 1225245665
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Entity Type | Organization
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Legal Business Name | KOESTLINE, INC.
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6952 SAINT ANDREWS RD ST. ANDREWS PRESBYTERIAN CHURCH
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City | COLUMBIA
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State | SC
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Zip | 29212-1143
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Country | US
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Telephone | 803-727-3460
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Fax |
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Provider Business Mailing Address
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Address Line | 1509 QUAIL VLY W
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City | COLUMBIA
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State | SC
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Zip | 29212-1536
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Country | US
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Telephone | 803-781-1565
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Fax |
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Authorized Official
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Title or Position | LPC
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Name | MR. W. CHARLES KOESTLINE JR.
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Credential | MA
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Telephone | 803-781-1565
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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 | 149
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License Number State | SC
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