Provider Demographics
NPI:1669652798
Name:WOODBRANCH CHILD AND FAMILY SUPPORT SERVICES, INC
Entity Type:Organization
Organization Name:WOODBRANCH CHILD AND FAMILY SUPPORT SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAMIEN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA, BS, LPC
Authorized Official - Phone:843-319-6958
Mailing Address - Street 1:741 CRAIG CIR
Mailing Address - Street 2:
Mailing Address - City:BENNETTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29512-2005
Mailing Address - Country:US
Mailing Address - Phone:843-319-6958
Mailing Address - Fax:910-277-6200
Practice Address - Street 1:821 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LAURINBURG
Practice Address - State:NC
Practice Address - Zip Code:28352-4724
Practice Address - Country:US
Practice Address - Phone:910-277-2600
Practice Address - Fax:910-277-6200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-06
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health