Provider Demographics
NPI:1225422983
Name:PALMETTO MOON COUNSELING AND CONSULTING SERVICES
Entity Type:Organization
Organization Name:PALMETTO MOON COUNSELING AND CONSULTING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANDA
Authorized Official - Middle Name:SHELLEY
Authorized Official - Last Name:STRICKLAND
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:843-421-5236
Mailing Address - Street 1:5445 HINSONS CROSSROADS
Mailing Address - Street 2:
Mailing Address - City:FAIR BLUFF
Mailing Address - State:NC
Mailing Address - Zip Code:28439
Mailing Address - Country:US
Mailing Address - Phone:843-421-5236
Mailing Address - Fax:
Practice Address - Street 1:6920 HIGHWAY 76
Practice Address - Street 2:
Practice Address - City:NICHOLS
Practice Address - State:SC
Practice Address - Zip Code:29581-5334
Practice Address - Country:US
Practice Address - Phone:843-421-5236
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-20
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4731251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health