=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871320770
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FAMILY ALLIANCE COUNSELING SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/16/2024
-----------------------------------------------------
Last Update Date | 01/31/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 81 POINTE CIR STE A
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29615-3505
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-238-0590
-----------------------------------------------------
Fax | 864-252-9300
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 25 WOODS LAKE RD STE 706
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29607-2764
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-238-0590
-----------------------------------------------------
Fax | 864-252-9300
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | FRIEDERIKE WILDAY
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 864-238-0590
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------