Provider Demographics
NPI:1538439450
Name:CENTER FOR COUNSELING & WELLNESS
Entity type:Organization
Organization Name:CENTER FOR COUNSELING & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBERTA
Authorized Official - Middle Name:J
Authorized Official - Last Name:BOGLE
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:843-663-0770
Mailing Address - Street 1:110 YE OLDE KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:NORTH MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29582-3050
Mailing Address - Country:US
Mailing Address - Phone:843-663-0770
Mailing Address - Fax:843-663-0772
Practice Address - Street 1:110 YE OLDE KINGS HWY
Practice Address - Street 2:
Practice Address - City:NORTH MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29582-3050
Practice Address - Country:US
Practice Address - Phone:843-663-0770
Practice Address - Fax:843-663-0772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-10
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5005101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty