Basic Information
| Provider Information | |||||||||
| NPI: | 1386281517 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CORDOVA COUNSELING AND CONSULTING, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2023 S IRBY ST # PMB342 | ||||||||
| Address2: | |||||||||
| City: | FLORENCE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295053419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8436765549 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2023 S IRBY ST # PMB342 | ||||||||
| Address2: | |||||||||
| City: | FLORENCE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295053419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8436765549 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2019 | ||||||||
| LastUpdateDate: | 12/06/2019 | ||||||||
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| AuthorizedOfficialLastName: | WOODS | ||||||||
| AuthorizedOfficialFirstName: | LAQUINAS | ||||||||
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| AuthorizedOfficialTitleorPosition: | SOCIAL WORKER/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8436765549 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | LISW-CP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.