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Organization
BLUFFTON OKATIE COUNSELING CENTER, LLC
Active
Organization
BLUFFTON OKATIE COUNSELING CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEIGH DIOTALEVI LISW-CP (ADMINISTRATOR)
(843) 636-5017
Entity
Organization
Contact information
Practice address
61 RIVERWALK BLVD STE H, RIDGELAND, SC 29936-3252
(843) 636-5017
(843) 206-0256
Mailing address
61 RIVERWALK BLVD STE H, RIDGELAND, SC 29936-3252
(843) 636-5017
(843) 206-0256
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
11563
SC
101YP2500X
Professional Counselor
—
NULL
101YP2500X
Professional Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
—
NULL
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PG1073
—
SC
Enumeration date
12/22/2017
Last updated
10/24/2022
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