MEDICARE: COMPANION COUNSELING AND COACHING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1003218371
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPANION COUNSELING AND COACHING

Provider Business Mailing Address
First Line	:	9 EXECUTIVE COURT
Second Line	:	SUITE #103
City	:	LAKE WYLIE
State	:	SC
Zip	:	29710-9338
Country	:	US
Telephone Number	:	803-265-8343
Fax Number	:	803-526-7635

Provider Business Practice Location Address
First Line	:	9 EXECUTIVE COURT
Second Line	:	SUITE #103
City	:	LAKE WYLIE
State	:	SC
Zip	:	29710-9338
Country	:	US
Telephone Number	:	803-265-8343
Fax Number	:	803-526-7635

Authorized Official
Title or Position	:	OWNER
Name	:	SHERITA F DAVIS
Credential	:	ME.D, LPC, LCMHC
Telephone Number	:	803-265-8343

Provider Enumeration Date	:	09/18/2014
Last Update Date	:	06/21/2021

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Directions to “COMPANION COUNSELING AND COACHING ” Practice Location

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