Provider Demographics
NPI:1346037272
Name:COUNTRY ROADS COUNSELING, LLC
Entity type:Organization
Organization Name:COUNTRY ROADS COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:LACARIA-HUTCHINSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:304-967-2358
Mailing Address - Street 1:862 HERITAGE DOWNS DR
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-1316
Mailing Address - Country:US
Mailing Address - Phone:304-967-2358
Mailing Address - Fax:304-362-9773
Practice Address - Street 1:862 HERITAGE DOWNS DR
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-1316
Practice Address - Country:US
Practice Address - Phone:304-967-2358
Practice Address - Fax:304-362-9773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-23
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)