MEDICARE: OPTIMA COUNSELING AND CONSULTING, 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	103T00000X	Psychologist

General Provider Information

NPI Number	:	1518359140
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTIMA COUNSELING AND CONSULTING, LLC

Provider Business Mailing Address
First Line	:	3505 PELHAM RD STE B
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29615-4154
Country	:	US
Telephone Number	:	864-991-3423
Fax Number	:	864-626-0010

Provider Business Practice Location Address
First Line	:	3505 PELHAM RD STE B
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29615-4154
Country	:	US
Telephone Number	:	864-991-3423
Fax Number	:	864-626-0010

Authorized Official
Title or Position	:	PARTNER
Name	:	DR. DAVID ALAN JONES
Credential	:	PH.D.
Telephone Number	:	864-991-3423

Provider Enumeration Date	:	02/18/2015
Last Update Date	:	03/07/2018

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