Provider Demographics
NPI:1427743673
Name:PEACEFUL WAVES COUNSELING LLC
Entity type:Organization
Organization Name:PEACEFUL WAVES COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:KUPCHA
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:802-363-6188
Mailing Address - Street 1:1016 2ND AVE N STE 203C
Mailing Address - Street 2:
Mailing Address - City:NORTH MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29582-3288
Mailing Address - Country:US
Mailing Address - Phone:802-363-6188
Mailing Address - Fax:
Practice Address - Street 1:1016 2ND AVE N STE 203C
Practice Address - Street 2:
Practice Address - City:NORTH MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29582-3288
Practice Address - Country:US
Practice Address - Phone:802-363-6188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-05
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty