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General NPI Number Information
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NPI Number | 1629653985
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Entity Type | Individual
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Provider Name | KERVIN SEARLES LPC
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Gender | Male
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Dates
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Enumeration Date | 03/17/2021
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Last Update Date | 06/29/2021
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Provider Practice Location Address
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Address Line | 104 MAXWELL AVE STE 219
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City | GREENWOOD
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State | SC
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Zip | 29646-2641
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Country | US
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Telephone | 864-724-9187
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Fax |
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Provider Business Mailing Address
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Address Line | 945 SUNSET DR
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City | GREENWOOD
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State | SC
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Zip | 29646-1807
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Country | US
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Telephone | 864-321-0108
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 7078
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 7754
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License Number State | SC
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