Provider Demographics
NPI:1053524934
Name:POSITIVE FEEDBACK PROFESSIONAL COUNSELING ASSOCIATES
Entity type:Organization
Organization Name:POSITIVE FEEDBACK PROFESSIONAL COUNSELING ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:SANTANA
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, NCC, CACI
Authorized Official - Phone:843-744-1447
Mailing Address - Street 1:5269 RIVERS AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-6311
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5269 RIVERS AVE
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-6311
Practice Address - Country:US
Practice Address - Phone:843-744-1447
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCOTP063251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health