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General NPI Number Information
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NPI Number | 1992638043
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Entity Type | Organization
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Legal Business Name | UPSTATE COUNSELING & CONSULTING LLC.
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Dates
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Enumeration Date | 06/08/2026
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Last Update Date | 06/08/2026
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Provider Practice Location Address
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Address Line | 112 W MAIN ST
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City | WALHALLA
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State | SC
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Zip | 29691-1929
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Country | US
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Telephone | 865-696-0678
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Fax |
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Provider Business Mailing Address
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Address Line | 512 ALRAD DR
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City | WALHALLA
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State | SC
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Zip | 29691-1882
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Country | US
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Telephone | 865-696-0678
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Fax |
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Authorized Official
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Title or Position | OWNER/CLINICIAN
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Name | MR. JAMES POLK COOLEY III
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Credential | LISW-CP
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Telephone | 865-696-0678
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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