| Radical Transformations Counseling Services Llc | |
|
630 Old Orangeburg Rd Apt A Lexington SC 29073-6927 | |
| (803) 727-0658 | |
| Not Available |
| Full Name | Radical Transformations Counseling Services Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 630 Old Orangeburg Rd Apt A, Lexington, South Carolina |
| Authorized Official Name and Position | Deana Lenette Tucker (CLINCIAL COUNSELOR) |
| Authorized Official Contact | 8037270658 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Radical Transformations Counseling Services Llc Po Box 8781 Columbia SC 29202-8781 Ph: (803) 727-0658 | Radical Transformations Counseling Services Llc 630 Old Orangeburg Rd Apt A Lexington SC 29073-6927 Ph: (803) 727-0658 |
| NPI Number | 1083144125 |
|---|---|
| Provider Enumeration Date | 06/12/2017 |
| Last Update Date | 06/11/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083144125 | NPI | - | NPPES |
| PC1559 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 6111 (South Carolina) | Primary |
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