Provider Demographics
NPI:1346794773
Name:FLORENCE DISTRICT ONE
Entity Type:Organization
Organization Name:FLORENCE DISTRICT ONE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TANISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:LPCI
Authorized Official - Phone:843-758-6849
Mailing Address - Street 1:1201 E ASHBY RD
Mailing Address - Street 2:
Mailing Address - City:QUINBY
Mailing Address - State:SC
Mailing Address - Zip Code:29506-7330
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1201 E ASHBY RD
Practice Address - Street 2:
Practice Address - City:QUINBY
Practice Address - State:SC
Practice Address - Zip Code:29506-7330
Practice Address - Country:US
Practice Address - Phone:843-758-6849
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-15
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSD2101251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health