NPIMap

Organization Active NPI

Etheria Counseling LLC

  • Mental Health Counselor
  • Myrtle Beach, SC
National Provider Identifier
1609546613
Registry record updated Aug 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
ETHERIA COUNSELING LLC
Practice address
1551 21St Ave N Ste 17
Myrtle Beach, SC 29577-7496
Phone
(843) 868-6200
Fax
(843) 868-6200
NPI assigned
Sep 20, 2021
Last updated
Aug 19, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2024

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

Authorized official

Name
Dr. Angel Corbin, LPCNPI 1699027961
Title
Owner
Phone
(843) 868-6200

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X
Mental Health Counselor 101YM0800X Primary
Clinical Social Worker 1041C0700X

Addresses

Primary practice location

1551 21St Ave N Ste 17
Myrtle Beach, SC 29577-7496

Mailing address

1551 21St Ave N Ste 17
Myrtle Beach, SC 29577-7496
Phone (843) 868-6200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241024000154 SC Part B Supplier - Clinic/Group Practice 0547793978 Receives reassigned benefits from 5 practitioners
Practice locations: Myrtle Beach, SC

National Provider Directory

National Provider Directory

Locations

1551 21st Ave N
Ste 17
Myrtle Beach, SC 29577
Phone (843) 868-6200

Practitioners & affiliated clinicians

Practitioners 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1632096000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724025600000",
    "number": "1609546613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1551 21ST AVE N STE 17",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295777496",
            "telephone_number": "843-868-6200",
            "fax_number": "843-868-6200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1551 21ST AVE N STE 17",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295777496",
            "telephone_number": "843-868-6200",
            "fax_number": "843-868-6200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ETHERIA COUNSELING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-20",
        "last_updated": "2024-08-19",
        "certification_date": "2024-08-19",
        "status": "A",
        "authorized_official_last_name": "CORBIN",
        "authorized_official_first_name": "ANGEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "843-868-6200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Myrtle Beach, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.