Provider Demographics
NPI:1275033870
Name:LAY-UP
Entity Type:Organization
Organization Name:LAY-UP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:803-236-2313
Mailing Address - Street 1:5640 TEAKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DALZELL
Mailing Address - State:SC
Mailing Address - Zip Code:29040-9652
Mailing Address - Country:US
Mailing Address - Phone:803-236-2313
Mailing Address - Fax:
Practice Address - Street 1:5640 TEAKWOOD DR
Practice Address - Street 2:
Practice Address - City:DALZELL
Practice Address - State:SC
Practice Address - Zip Code:29040-9652
Practice Address - Country:US
Practice Address - Phone:803-236-2313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-20
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty