Provider Demographics
NPI:1619939873
Name:CHARLESTON FAMILY CENTER, LLC
Entity Type:Organization
Organization Name:CHARLESTON FAMILY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
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:29407-6048
Mailing Address - Country:US
Mailing Address - Phone:843-763-2222
Mailing Address - Fax:843-766-5705
Practice Address - Street 1:4 CARRIAGE LN
Practice Address - Street 2:SUITE 100
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-6048
Practice Address - Country:US
Practice Address - Phone:843-763-2222
Practice Address - Fax:843-766-5705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-04
Last Update Date:2008-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6767106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3347Medicaid
SCDG5930OtherRR MEDICARE
SCGP3347Medicaid