Provider Demographics
NPI:1124630868
Name:THE FAMILY CENTER OF AIKEN COUNTY, LLC
Entity type:Organization
Organization Name:THE FAMILY CENTER OF AIKEN COUNTY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:EDGAR
Authorized Official - Middle Name:JOE
Authorized Official - Last Name:HOLT
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHD
Authorized Official - Phone:803-752-0404
Mailing Address - Street 1:1117 GEORGIA AVE STE D
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29841-6127
Mailing Address - Country:US
Mailing Address - Phone:803-752-0404
Mailing Address - Fax:888-384-2250
Practice Address - Street 1:1117 GEORGIA AVE STE D
Practice Address - Street 2:
Practice Address - City:NORTH AUGUSTA
Practice Address - State:SC
Practice Address - Zip Code:29841-6127
Practice Address - Country:US
Practice Address - Phone:803-752-0404
Practice Address - Fax:888-384-2250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-22
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty