=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285861344
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CONNECTING DOTS COUNSELING SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/16/2009
-----------------------------------------------------
Last Update Date | 04/26/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 114 GATEWAY CORPORATE BLVD SUITE 320
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29203-9740
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-865-3034
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 114 GATEWAY CORPORATE BLVD SUITE 320
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29203-9740
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-865-3034
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COUNSELOR
-----------------------------------------------------
Name | MRS. KATRINA REMONIA WILLIAMS
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 803-865-3034
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 4614
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------