Provider Demographics
NPI:1942611066
Name:COMMONGROUND COUNSELING AND LIFE COACHING
Entity type:Organization
Organization Name:COMMONGROUND COUNSELING AND LIFE COACHING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, CLINICAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC-I
Authorized Official - Phone:803-322-5242
Mailing Address - Street 1:242 SIX MILE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:SC
Mailing Address - Zip Code:29720-9719
Mailing Address - Country:US
Mailing Address - Phone:803-322-5242
Mailing Address - Fax:
Practice Address - Street 1:242 SIX MILE CREEK RD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720-9719
Practice Address - Country:US
Practice Address - Phone:803-322-5242
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-12
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5690101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty