Provider Demographics
NPI:1245537661
Name:CHARLESTON PSYCHODYNAMICS LLC
Entity type:Organization
Organization Name:CHARLESTON PSYCHODYNAMICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALBERTO
Authorized Official - Middle Name:B
Authorized Official - Last Name:SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:843-597-7683
Mailing Address - Street 1:44 CHARLOTTE ST
Mailing Address - Street 2:UNIT C
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29403-6370
Mailing Address - Country:US
Mailing Address - Phone:843-597-7683
Mailing Address - Fax:843-556-0300
Practice Address - Street 1:669 SAINT ANDREWS BLVD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-7165
Practice Address - Country:US
Practice Address - Phone:843-556-5502
Practice Address - Fax:843-556-0300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-21
Last Update Date:2011-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty