Provider Demographics
NPI:1619418779
Name:PALMETTO COUNSELING OF HARTSVILLE LLC
Entity Type:Organization
Organization Name:PALMETTO COUNSELING OF HARTSVILLE LLC
Other - Org Name:PALMETTO COUNSELING OF HARTSVILLE, LLP
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:LPC
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:SUZANNE
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:843-307-4762
Mailing Address - Street 1:5003 UNA RD
Mailing Address - Street 2:
Mailing Address - City:HARTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29550-1954
Mailing Address - Country:US
Mailing Address - Phone:843-453-9985
Mailing Address - Fax:
Practice Address - Street 1:5003 UNA RD
Practice Address - Street 2:
Practice Address - City:HARTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29550-1954
Practice Address - Country:US
Practice Address - Phone:843-453-9985
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-09
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5487101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty