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General NPI Number Information
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NPI Number | 1467874305
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Entity Type | Organization
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Legal Business Name | PARAKLETOS333
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Dates
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Enumeration Date | 01/13/2014
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Last Update Date | 01/13/2014
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Provider Practice Location Address
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Address Line | 3 GAMECOCK AVE SUITE 304
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City | CHARLESTON
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State | SC
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Zip | 29407-3378
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Country | US
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Telephone | 843-640-6882
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Fax |
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Provider Business Mailing Address
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Address Line | 173 MARY ELLEN DR
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City | CHARLESTON
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State | SC
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Zip | 29403-3355
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Country | US
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Telephone | 843-259-9433
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Fax |
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Authorized Official
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Title or Position | COUNSELOR
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Name | MRS. DIANE ELIZABETH ARNOLD
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Credential | MA, LPC
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Telephone | 843-259-9433
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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 | 5604
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License Number State | SC
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