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General NPI Number Information
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NPI Number | 1407644297
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Entity Type | Organization
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Legal Business Name | PBA COUNSELING
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Dates
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Enumeration Date | 04/30/2025
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Last Update Date | 04/01/2026
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Provider Practice Location Address
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Address Line | 34 GAITED ACRES LN
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City | BLYTHEWOOD
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State | SC
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Zip | 29016-5713
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Country | US
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Telephone | 839-292-3902
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Fax |
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Provider Business Mailing Address
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Address Line | 9153 TWO NOTCH RD STE C11
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City | COLUMBIA
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State | SC
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Zip | 29223-5853
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Country | US
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Telephone | 839-292-3902
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SASHA FARR-GOODWIN
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Credential | LISW-CP
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Telephone | 839-292-3902
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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