Provider Demographics
NPI:1104564970
Name:SISTAS OF ENCOURAGEMENT
Entity type:Organization
Organization Name:SISTAS OF ENCOURAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LANIECE
Authorized Official - Middle Name:
Authorized Official - Last Name:AJAVON
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC-A
Authorized Official - Phone:843-999-5525
Mailing Address - Street 1:PO BOX 1531
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29528-1531
Mailing Address - Country:US
Mailing Address - Phone:843-999-5525
Mailing Address - Fax:
Practice Address - Street 1:2405 FARMWOOD CIR
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29527-3128
Practice Address - Country:US
Practice Address - Phone:843-999-5525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty