Provider Demographics
NPI:1578702072
Name:HART BEHAVIORAL HEALTH LLC
Entity Type:Organization
Organization Name:HART BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:HART
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC, LPCS, NCC
Authorized Official - Phone:843-679-9200
Mailing Address - Street 1:503 RIDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-5519
Mailing Address - Country:US
Mailing Address - Phone:843-679-9200
Mailing Address - Fax:843-665-8676
Practice Address - Street 1:503 RIDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-5519
Practice Address - Country:US
Practice Address - Phone:843-679-9200
Practice Address - Fax:843-665-8676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-07
Last Update Date:2009-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLPC 1922101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty