Provider Demographics
NPI:1023019478
Name:PROFESSIONAL COUNSELING ASSOCIATES, INC.
Entity type:Organization
Organization Name:PROFESSIONAL COUNSELING ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:D
Authorized Official - Last Name:MURDEN
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:910-287-4022
Mailing Address - Street 1:1131 ASH LITTLE RIVER RD
Mailing Address - Street 2:
Mailing Address - City:ASH
Mailing Address - State:NC
Mailing Address - Zip Code:28420-1717
Mailing Address - Country:US
Mailing Address - Phone:910-287-4022
Mailing Address - Fax:
Practice Address - Street 1:1304 C AZALEA COURT
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-5723
Practice Address - Country:US
Practice Address - Phone:843-997-4022
Practice Address - Fax:843-215-2444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2013-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC52991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ315687198Medicare PIN
SC7198Medicare PIN