Organization
BRECKENRIDGE COUNSELING SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHERRY L VAN FOSSAN LISW-CP (OWNER/SOLE PRACTIONER)
(732) 245-8505
Entity
Organization
Contact information
Practice address
200 N MAIN ST STE 301E, GREENVILLE, SC 29601-5104
(732) 245-8505
(000) 000-0000
Mailing address
98 E MCBEE AVE UNIT 314, GREENVILLE, SC 29601-4881
(732) 245-8505
(000) 000-0000
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
12010
SC
Other
Enumeration date
08/28/2017
Last updated
08/28/2017
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