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General NPI Number Information
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NPI Number | 1417341611
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Entity Type | Organization
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Legal Business Name | FULLCIRCLE COUNSELING SERVICE AND CONSULTATION
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Dates
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Enumeration Date | 03/25/2015
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Last Update Date | 03/25/2015
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Provider Practice Location Address
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Address Line | 105 PACES BROOK AVE #518
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City | COLUMBIA
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State | SC
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Zip | 29212-1642
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Country | US
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Telephone | 803-467-4125
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Fax | 803-569-6523
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Provider Business Mailing Address
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Address Line | 105 PACES BROOK AVE #518
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City | COLUMBIA
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State | SC
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Zip | 29212-1642
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Country | US
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Telephone | 803-467-4125
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Fax | 803-569-6523
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Authorized Official
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Title or Position | OWNER
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Name | KENNETH LEON MARTIN
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Credential | LPC
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Telephone | 803-467-4125
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 4911
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License Number State | SC
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