MEDICARE: TRIY COUNSELING SERVICES, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251S00000X	Community/Behavioral Health Agency
2	101YM0800X	Mental Health Counselor
3	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1457820326
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRIY COUNSELING SERVICES, LLC

Provider Business Mailing Address
First Line	:	2629 LIBERTY HILL RD UNIT 2024
Second Line	:
City	:	CAMDEN
State	:	SC
Zip	:	29020-1874
Country	:	US
Telephone Number	:	803-560-8208
Fax Number	:	803-560-8210

Provider Business Practice Location Address
First Line	:	1717 GERVAIS ST STE 104
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29201-3415
Country	:	US
Telephone Number	:	803-560-8208
Fax Number	:	803-560-8210

Authorized Official
Title or Position	:	CLINICAL SOCIAL WORKER/DIRECTOR
Name	:	LOUIS QUAMAINE CARN
Credential	:	LISW-CP
Telephone Number	:	803-560-8208

Provider Enumeration Date	:	11/20/2018
Last Update Date	:	08/16/2024

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