Provider Demographics
NPI:1588305163
Name:CHARLESTON INTEGRATED COUNSELING, LLC
Entity type:Organization
Organization Name:CHARLESTON INTEGRATED COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:KREUTNER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:843-327-9820
Mailing Address - Street 1:751 LONGBRANCH DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-5468
Mailing Address - Country:US
Mailing Address - Phone:843-256-3357
Mailing Address - Fax:
Practice Address - Street 1:751 LONGBRANCH DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-5468
Practice Address - Country:US
Practice Address - Phone:843-256-3357
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-06
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)