MEDICARE: CHALLENGES, LLC

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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1295010544
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHALLENGES, LLC

Provider Business Mailing Address
First Line	:	PO BOX 1427
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29202-1427
Country	:	US
Telephone Number	:	803-765-1838
Fax Number	:	803-765-1732

Provider Business Practice Location Address
First Line	:	103 N LAFAYETTE ST
Second Line	:
City	:	SHELBY
State	:	NC
Zip	:	28150-4445
Country	:	US
Telephone Number	:	704-487-0889
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DORI STARKS
Credential	:
Telephone Number	:	704-487-0889

Provider Enumeration Date	:	10/19/2011
Last Update Date	:	10/25/2011

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