Provider Demographics
NPI:1790351666
Name:PALMETTO STATE PCIT, LLC
Entity Type:Organization
Organization Name:PALMETTO STATE PCIT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRATCHER
Authorized Official - Suffix:
Authorized Official - Credentials:LISW-CP
Authorized Official - Phone:843-321-7107
Mailing Address - Street 1:198 OKATIE VILLAGE DR STE 103-332
Mailing Address - Street 2:
Mailing Address - City:OKATIE
Mailing Address - State:SC
Mailing Address - Zip Code:29909-7527
Mailing Address - Country:US
Mailing Address - Phone:843-321-7107
Mailing Address - Fax:843-326-4806
Practice Address - Street 1:26 HEARTWOOD CT
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-9560
Practice Address - Country:US
Practice Address - Phone:843-321-7107
Practice Address - Fax:843-326-4806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-01
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty