1568858165 NPI number — YOUR COUNSELING SERVICES INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568858165 NPI number — YOUR COUNSELING SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
YOUR COUNSELING SERVICES INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568858165
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6650 RIVERS AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH CHARLESTON
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29406-4809
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-260-5361
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6650 RIVERS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH CHARLESTON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29406-4809
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-260-5361
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/09/2015

Additional Information

Authorized Official

Authorized Official Last Name:
FRAISER
Authorized Official First Name:
KEM
Authorized Official Middle Name:
D
Authorized Official Title or Position:
PROVIDER
Authorized Official Telephone Number:
843-260-5361

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X , with the licence number: HA1007 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103K00000X , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: HA1007 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0835902 . This is a "ARTICLES OF INCORPORATION" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 11850682 . This is a "CAQH PROVIDER ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 638940225B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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