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General NPI Number Information
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NPI Number | 1417283524
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Entity Type | Organization
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Legal Business Name | PURE SERENITY CONSULTANT AND COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 10/23/2009
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Last Update Date | 12/08/2009
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Provider Practice Location Address
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Address Line | 112 EXCHANGE ST
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City | DARLINGTON
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State | SC
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Zip | 29532-3204
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Country | US
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Telephone | 843-687-4183
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Fax |
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Provider Business Mailing Address
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Address Line | 2550 KINGSTON DR
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City | FLORENCE
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State | SC
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Zip | 29505-6423
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Country | US
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Telephone | 843-687-4183
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. EDNA NICOLE COGDELL-QUICK
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Credential | LPC
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Telephone | 843-687-4183
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 0603302
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 4711
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License Number State | SC
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