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General NPI Number Information
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NPI Number | 1942917604
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Entity Type | Organization
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Legal Business Name | PEACE OF MINE COUNSELING AND CONSULTATION
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Dates
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Enumeration Date | 11/02/2022
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Last Update Date | 11/02/2022
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Provider Practice Location Address
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Address Line | 106 W GEORGIA RD
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City | SIMPSONVILLE
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State | SC
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Zip | 29681-2302
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Country | US
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Telephone | 843-709-3392
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Fax |
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Provider Business Mailing Address
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Address Line | 24 MIDDLEFIELD CT
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City | SIMPSONVILLE
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State | SC
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Zip | 29680-7054
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Country | US
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Telephone | 843-709-3392
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Fax |
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Authorized Official
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Title or Position | OWNER/COUNSELOR
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Name | MRS. KANISHA FORDHAM MILLER
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Credential | LPC, LAC
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Telephone | 843-709-3392
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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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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