Provider Demographics
NPI:1598072282
Name:PALMETTO LOWCOUNTRY BEHAVIORAL HEALTH, LLC
Entity Type:Organization
Organization Name:PALMETTO LOWCOUNTRY BEHAVIORAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CHERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TOLLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-747-5830
Mailing Address - Street 1:2777 SPEISSEGGER DR.
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29405-8235
Mailing Address - Country:US
Mailing Address - Phone:843-747-5830
Mailing Address - Fax:843-745-5115
Practice Address - Street 1:2777 SPEISSEGGER DR.
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405-8235
Practice Address - Country:US
Practice Address - Phone:843-747-5830
Practice Address - Fax:843-745-5115
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PALMETTO LOWCOUNTRY BEHAVIORAL HEALTH, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-02
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCA00729Medicaid
SCRTF021Medicaid
SC424006Medicare UPIN