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General NPI Number Information
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NPI Number | 1750346532
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Entity Type | Organization
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Legal Business Name | EAGLE'S NEST COUNSELING, LLC
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Dates
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Enumeration Date | 04/17/2006
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Last Update Date | 10/20/2009
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Provider Practice Location Address
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Address Line | 2025 EBENEZER RD K-5
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City | ROCK HILL
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State | SC
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Zip | 29732-1062
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Country | US
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Telephone | 803-322-1383
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 37084
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City | ROCK HILL
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State | SC
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Zip | 29732-0518
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Country | US
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Telephone | 803-322-1383
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DONNA L FAILE
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Credential | LPC
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Telephone | 803-322-1383
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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 | 3522
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License Number State | NC
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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 | 3719
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License Number State | SC
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