Surfside Counseling, LLC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

Legal business name

SURFSIDE COUNSELING, LLC

Doing business as

Surfside Counseling, LLC

Practice address

1500 North Hwy 17 Business
Suite 104
Surfside Beach, SC 29575

Phone

(843) 333-8624

Fax

(888) 274-0122

NPI assigned

Jan 10, 2019

Last updated

Jan 10, 2019By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Kristina Carter Goodall, LPCNPI 1396061198

Title

Counselor

Phone

(843) 333-8624

Specialties & licenses 1

Addresses

Other names 1

• Surfside Counseling, LLC Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kristina C Goodall

  • Professional Counselor
  • Surfside Beach, SC
  • NPI 1396061198
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1547078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1547078400000",
    "number": "1518430693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 NORTH HWY 17 BUSINESS",
            "address_2": "SUITE 104",
            "city": "SURFSIDE BEACH",
            "state": "SC",
            "postal_code": "29575",
            "telephone_number": "843-333-8624",
            "fax_number": "888-274-0122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 NORTH HWY 17 BUSINESS",
            "address_2": "SUITE 104",
            "city": "SURFSIDE BEACH",
            "state": "SC",
            "postal_code": "29575",
            "telephone_number": "843-333-8624",
            "fax_number": "888-274-0122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SURFSIDE COUNSELING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-10",
        "last_updated": "2019-01-10",
        "status": "A",
        "authorized_official_last_name": "GOODALL",
        "authorized_official_first_name": "KRISTINA",
        "authorized_official_middle_name": "CARTER",
        "authorized_official_title_or_position": "COUNSELOR",
        "authorized_official_telephone_number": "843-333-8624",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Surfside Counseling, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Susan Edwards Surratt, FNP
• Autumn Tami, PHARMD
• Cameron James Tansey, DMD

• Professional Counselor in Surfside Beach, SC
• Providers in Surfside Beach, SC by specialty
• Professional Counselor in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.