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General NPI Number Information
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NPI Number | 1225776198
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Entity Type | Organization
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Legal Business Name | TRIPLE MOON COUNSELING LLC
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Dates
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Enumeration Date | 05/21/2022
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Last Update Date | 05/21/2022
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Provider Practice Location Address
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Address Line | 211 W TRADE ST
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City | SIMPSONVILLE
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State | SC
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Zip | 29681-2609
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Country | US
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Telephone | 864-907-9159
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Fax |
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Provider Business Mailing Address
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Address Line | 307 HYDE PARK LN
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City | MAULDIN
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State | SC
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Zip | 29662-3174
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Country | US
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Telephone | 864-275-5809
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SARAH ANDERSON
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Credential | LPC, LAC
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Telephone | 864-275-5809
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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