Provider Demographics
NPI:1588252712
Name:CSOG LLC
Entity type:Organization
Organization Name:CSOG LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRITTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:CLOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-326-4696
Mailing Address - Street 1:4006 E NORTH ST STE C
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-6206
Mailing Address - Country:US
Mailing Address - Phone:864-326-4696
Mailing Address - Fax:864-660-9542
Practice Address - Street 1:4006 E NORTH ST STE C
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-6206
Practice Address - Country:US
Practice Address - Phone:864-326-4696
Practice Address - Fax:864-660-9542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-04
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty