=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336502988
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NWC COUNSELING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/31/2016
-----------------------------------------------------
Last Update Date | 03/31/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2212 DEVINE ST SUITE D
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29205-2402
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-295-0609
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1671 RABON FARMS LN
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29223-5880
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-295-0609
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/COUNSELOR
-----------------------------------------------------
Name | NIYA CALDERON
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 803-295-0609
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | 5720
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------