# BLUFFTON OKATIE COUNSELING CENTER, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1225544562
- **Authorized official:** LEIGH DIOTALEVI LISW-CP (ADMINISTRATOR)
- **Authorized official phone:** (843) 636-5017

## Contact information

- **Practice address:** 61 RIVERWALK BLVD STE H, RIDGELAND, SC 29936-3252
- **Practice address phone:** (843) 636-5017
- **Practice address fax:** (843) 206-0256
- **Mailing address:** 61 RIVERWALK BLVD STE H, RIDGELAND, SC 29936-3252
- **Mailing address phone:** (843) 636-5017
- **Mailing address fax:** (843) 206-0256

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | 11563 | SC | — |
| 101YP2500X | Professional Counselor | — | NULL | — |
| 101YP2500X | Professional Counselor | — | — | — |
| 1041C0700X | Clinical Social Worker | — | NULL | Yes |
| 1041C0700X | Clinical Social Worker | — | — | Yes |

## Other

- **Enumeration date:** 12/22/2017
- **Last updated:** 10/24/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | PG1073 | — | SC |