MEDICARE: PEACEFUL PLACE COUNSELING CENTER 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	:	1437726536
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEACEFUL PLACE COUNSELING CENTER LLC

Provider Business Mailing Address
First Line	:	201 ANDREWS AVE N
Second Line	:
City	:	GREENWOOD
State	:	SC
Zip	:	29646-2103
Country	:	US
Telephone Number	:	864-321-4565
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 ANDREWS AVE N
Second Line	:
City	:	GREENWOOD
State	:	SC
Zip	:	29646-2103
Country	:	US
Telephone Number	:	864-321-4565
Fax Number	:

Authorized Official
Title or Position	:	LICENSED PROFESSIONAL COUNSELOR
Name	:	BRITTANEY HUGHES CONYERS
Credential	:	LPC
Telephone Number	:	864-321-4565

Provider Enumeration Date	:	06/07/2021
Last Update Date	:	06/07/2021

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