Provider Demographics
NPI:1508385469
Name:PALMETTO COMMUNITY GROUP, LLC
Entity Type:Organization
Organization Name:PALMETTO COMMUNITY GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATASHA
Authorized Official - Middle Name:R
Authorized Official - Last Name:BRANON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:803-636-7951
Mailing Address - Street 1:402 NAUTIQUE CIR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-7334
Mailing Address - Country:US
Mailing Address - Phone:803-546-0313
Mailing Address - Fax:
Practice Address - Street 1:22 OFFICE PARK CT STE F
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-5965
Practice Address - Country:US
Practice Address - Phone:803-636-7951
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-12
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 251S00000X, 252Y00000X
SC4993101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Multi-Specialty