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General NPI Number Information
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NPI Number | 1437663671
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Entity Type | Organization
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Legal Business Name | GRAYSON COUNSELING AND CONSULTING SERVICES LLC
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Dates
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Enumeration Date | 11/27/2017
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Last Update Date | 05/11/2022
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Provider Practice Location Address
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Address Line | 136 FORUM DR STE 4
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City | COLUMBIA
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State | SC
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Zip | 29229-7980
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Country | US
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Telephone | 803-590-8924
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Fax |
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Provider Business Mailing Address
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Address Line | 136 FORUM DR STE 4
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City | COLUMBIA
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State | SC
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Zip | 29229-7980
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Country | US
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Telephone | 803-590-8924
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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. OPAL KNIGHT
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Credential | MA, MHA, LPC, BC-TMH
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Telephone | 803-590-8924
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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 | 5688
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License Number State | SC
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