Provider Demographics
NPI:1235435272
Name:PALMETTO YOUTH AND FAMILY SERVICES
Entity Type:Organization
Organization Name:PALMETTO YOUTH AND FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NATASHA
Authorized Official - Middle Name:RENA'
Authorized Official - Last Name:BRANON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:803-546-0313
Mailing Address - Street 1:16101 WRIGHTS FERRY RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28278-7635
Mailing Address - Country:US
Mailing Address - Phone:803-546-0313
Mailing Address - Fax:
Practice Address - Street 1:16101 WRIGHTS FERRY RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28278-7635
Practice Address - Country:US
Practice Address - Phone:803-546-0313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-09
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4993251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPC1027Medicaid