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General NPI Number Information
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NPI Number | 1417234394
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Entity Type | Organization
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Legal Business Name | ESSENTIAL BEHAVIOR COUNSELING SERVICES LLC
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Dates
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Enumeration Date | 11/07/2011
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Last Update Date | 08/28/2012
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Provider Practice Location Address
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Address Line | 131 POPLAR STREET ROOM 114
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City | BOWMAN
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State | SC
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Zip | 29018
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Country | US
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Telephone | 803-290-6860
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Fax |
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Provider Business Mailing Address
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Address Line | 2344 NORTHVIEW DR APT 3E
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City | ORANGEBURG
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State | SC
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Zip | 29118-2973
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Country | US
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Telephone | 803-290-6860
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Fax |
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Authorized Official
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Title or Position | CO CEO/ CO CEO
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Name | HOPE/GREGORY GAINES/EVANS
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Credential |
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Telephone | 803-290-6860
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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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 | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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