1992847248 NPI number — CANTERBURY COUNSELING CENTER

Table of content: (NPI 1992847248)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992847248 NPI number — CANTERBURY COUNSELING CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CANTERBURY COUNSELING CENTER
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:
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:
1992847248
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7 PETTIGRU ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENVILLE
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29601-3000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-235-7501
Provider Business Mailing Address Fax Number:
864-235-7503

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7 PETTIGRU ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENVILLE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29601-3000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-235-7501
Provider Business Practice Location Address Fax Number:
864-235-7503
Provider Enumeration Date:
02/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CROOKS
Authorized Official First Name:
MARION
Authorized Official Middle Name:
B
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
864-235-7501

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  3664 , 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: 29260P001 . This is a "PLANNED ADMINISTRATORS" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 68131M001 . This is a "MUTUAL OF OMAHA" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 29219B001 . This is a "BCBS OF SC" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 17089H001 . This is a "HIGHMARK, INC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 29219T001 . This is a "TRICARE FOR LIFE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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