Provider Demographics
NPI:1639493828
Name:THE ERNEST E KENNEDY CENTER
Entity Type:Organization
Organization Name:THE ERNEST E KENNEDY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PORCHER
Authorized Official - Middle Name:
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:MA CACII
Authorized Official - Phone:843-797-7871
Mailing Address - Street 1:96 WISTERIA RD
Mailing Address - Street 2:
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-3495
Mailing Address - Country:US
Mailing Address - Phone:843-797-7871
Mailing Address - Fax:
Practice Address - Street 1:96 WISTERIA RD
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-3495
Practice Address - Country:US
Practice Address - Phone:843-797-7871
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-17
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health