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General NPI Number Information
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NPI Number | 1568343515
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Entity Type | Organization
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Legal Business Name | DISRUPTIVE THINKING COUNSELING LLC
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Dates
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Enumeration Date | 09/08/2025
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Last Update Date | 09/08/2025
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Provider Practice Location Address
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Address Line | 45 MOULTRIE ST
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City | CHARLESTON
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State | SC
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Zip | 29403-4132
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Country | US
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Telephone | 843-437-2836
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Fax |
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Provider Business Mailing Address
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Address Line | 45 MOULTRIE ST
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City | CHARLESTON
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State | SC
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Zip | 29403-4132
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Country | US
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Telephone | 843-437-2836
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Fax |
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Authorized Official
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Title or Position | BUSINESS OWNER
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Name | SHAMA TICSHERA WINSTON-FORD
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Credential | LPC
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Telephone | 843-437-2836
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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