Provider Demographics
NPI:1730212028
Name:YOUR COUNSELING SERVICES INC
Entity type:Organization
Organization Name:YOUR COUNSELING SERVICES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INTERNATIONAL ASSOCIATION OF CLINIC
Authorized Official - Prefix:MS
Authorized Official - First Name:KEM
Authorized Official - Middle Name:DENICE
Authorized Official - Last Name:FRASIER
Authorized Official - Suffix:
Authorized Official - Credentials:IACTP
Authorized Official - Phone:843-260-5361
Mailing Address - Street 1:6650 RIVERS AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-4809
Mailing Address - Country:US
Mailing Address - Phone:843-260-5361
Mailing Address - Fax:
Practice Address - Street 1:6650 RIVERS AVE
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-4809
Practice Address - Country:US
Practice Address - Phone:843-576-5400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
11850682OtherCAQH PROVIDER ID
SC=========OtherEIN
GANONEOtherCERTIFIED SERVICE COORDINATOR FOR BABIES CAN'T WAIT PROGRAM
GA638940225BMedicaid
NC0835902OtherARTICLES OF INCORPORATION
NC=========OtherEIN