Provider Demographics
NPI:1801777933
Name:COMMODORE EDUCATIONAL CONSULTING AND COUNSELING INSTITUTE, LLC
Entity type:Organization
Organization Name:COMMODORE EDUCATIONAL CONSULTING AND COUNSELING INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:ADASSA
Authorized Official - Last Name:COMMODORE
Authorized Official - Suffix:
Authorized Official - Credentials:LISW-CP
Authorized Official - Phone:803-321-6657
Mailing Address - Street 1:PO BOX 62
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:SC
Mailing Address - Zip Code:29560-0062
Mailing Address - Country:US
Mailing Address - Phone:843-307-9566
Mailing Address - Fax:
Practice Address - Street 1:4029 MCGEE RD
Practice Address - Street 2:
Practice Address - City:COWARD
Practice Address - State:SC
Practice Address - Zip Code:29530-5232
Practice Address - Country:US
Practice Address - Phone:843-307-9566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-08
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)