| Csog Llc | |
|
4006 E North St Ste C Greenville SC 29615-6206 | |
| (864) 326-4696 | |
| (864) 660-9542 |
| Full Name | Csog Llc |
|---|---|
| Speciality | Counselor |
| Location | 4006 E North St Ste C, Greenville, South Carolina |
| Authorized Official Name and Position | Brittney Clow (OWNER) |
| Authorized Official Contact | 8643264696 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Csog Llc 4006 E North St Ste C Greenville SC 29615-6206 Ph: (864) 326-4696 | Csog Llc 4006 E North St Ste C Greenville SC 29615-6206 Ph: (864) 326-4696 |
| NPI Number | 1588252712 |
|---|---|
| Provider Enumeration Date | 01/04/2021 |
| Last Update Date | 01/04/2021 |
| Certification Date | 01/04/2021 |
| Medicare PECOS PAC ID | 3678954120 |
|---|---|
| Medicare Enrollment ID | O20220715000586 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588252712 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Brittney Lj Clow |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1275832339 PECOS PAC ID: 0042450546 Enrollment ID: I20220715000697 |
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