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General NPI Number Information
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NPI Number | 1437457520
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Entity Type | Organization
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Legal Business Name | AVILLAGE COUNSELING GROUP LLC
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Dates
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Enumeration Date | 03/14/2011
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Last Update Date | 03/14/2011
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Provider Practice Location Address
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Address Line | 112K WHITE OAK LN
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City | LEXINGTON
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State | SC
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Zip | 29073-9465
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Country | US
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Telephone | 803-936-1910
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Fax |
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Provider Business Mailing Address
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Address Line | 112K WHITE OAK LN
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City | LEXINGTON
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State | SC
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Zip | 29073-9465
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Country | US
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Telephone | 803-936-1910
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. HERBERT ADDISON
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Credential | J.D., CHC
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Telephone | 803-936-1910
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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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