Provider Demographics
NPI:1518358696
Name:PALMETTO SUPPORTIVE SERVICES
Entity Type:Organization
Organization Name:PALMETTO SUPPORTIVE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:864-346-2800
Mailing Address - Street 1:25 WOODS LAKE RD STE 301
Mailing Address - Street 2:SUITE 301
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-2762
Mailing Address - Country:US
Mailing Address - Phone:864-346-2800
Mailing Address - Fax:864-272-1974
Practice Address - Street 1:25 WOODS LAKE RD STE 301
Practice Address - Street 2:SUITE 301
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-2762
Practice Address - Country:US
Practice Address - Phone:864-346-2800
Practice Address - Fax:864-272-1974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-11
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty