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General NPI Number Information
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NPI Number | 1225317969
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Entity Type | Organization
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Legal Business Name | SOUTHEAST COUNSELING & CONSULTING, LLC
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Dates
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Enumeration Date | 08/11/2011
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Last Update Date | 12/03/2011
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Provider Practice Location Address
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Address Line | 2712 MIDDLEBURG DR SUITE 207B
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City | COLUMBIA
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State | SC
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Zip | 29204-2415
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Country | US
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Telephone | 803-238-5063
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Fax | 803-419-7497
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Provider Business Mailing Address
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Address Line | 2712 MIDDLEBURG DR SUITE 207B
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City | COLUMBIA
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State | SC
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Zip | 29204-2415
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Country | US
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Telephone | 803-238-5063
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Fax | 803-419-7497
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Authorized Official
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Title or Position | COUNSELOR
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Name | MRS. MICHELLE GOODWIN DRAYTON
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Credential | LPC
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Telephone | 803-238-5063
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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 | 5337
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License Number State | SC
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