Provider Demographics
NPI:1578789491
Name:CHARLESTON FAMILY CENTER, LLC IN WALTERBORO
Entity Type:Organization
Organization Name:CHARLESTON FAMILY CENTER, LLC IN WALTERBORO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-763-2222
Mailing Address - Street 1:4 CARRIAGE LN
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-6065
Mailing Address - Country:US
Mailing Address - Phone:843-763-2222
Mailing Address - Fax:
Practice Address - Street 1:303 MAXEY ST
Practice Address - Street 2:
Practice Address - City:WALTERBORO
Practice Address - State:SC
Practice Address - Zip Code:29488-2546
Practice Address - Country:US
Practice Address - Phone:843-549-7664
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty