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General NPI Number Information
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NPI Number | 1447078233
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Entity Type | Organization
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Legal Business Name | SC PROFESSIONAL SERVICES, LLC
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Dates
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Enumeration Date | 09/30/2024
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Last Update Date | 11/08/2024
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Provider Practice Location Address
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Address Line | 1064 GARDNER RD STE 215
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City | CHARLESTON
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State | SC
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Zip | 29407-1712
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Country | US
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Telephone | 843-779-7718
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Fax | 404-920-3484
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Provider Business Mailing Address
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Address Line | 1064 GARDNER RD STE 215
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City | CHARLESTON
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State | SC
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Zip | 29407-1712
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Country | US
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Telephone | 843-779-7718
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Fax | 404-920-3484
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | MS. KASSI GOODMAN
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Credential | LPC
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Telephone | 843-779-7718
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) 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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207RA0401X
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Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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