Provider Demographics
NPI:1396016416
Name:LETS MAKE A DIFFERENCE
Entity Type:Organization
Organization Name:LETS MAKE A DIFFERENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANTONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:843-627-1012
Mailing Address - Street 1:PO BOX 2104
Mailing Address - Street 2:
Mailing Address - City:DILLON
Mailing Address - State:SC
Mailing Address - Zip Code:29536-7104
Mailing Address - Country:US
Mailing Address - Phone:842-627-1012
Mailing Address - Fax:843-627-0101
Practice Address - Street 1:1409 HIGHWAY 301 N
Practice Address - Street 2:
Practice Address - City:DILLON
Practice Address - State:SC
Practice Address - Zip Code:29536-2165
Practice Address - Country:US
Practice Address - Phone:842-627-1012
Practice Address - Fax:843-627-0101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-20
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6377251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health