Provider Demographics
NPI:1396214987
Name:IT'S YOUR MOVE
Entity type:Organization
Organization Name:IT'S YOUR MOVE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHEIF OPERATIONS OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DEENEKA
Authorized Official - Middle Name:LACHELLE
Authorized Official - Last Name:BEACH-PHELPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-217-0747
Mailing Address - Street 1:425 SUMMIT TERRACE CT BLDG 7B
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-7055
Mailing Address - Country:US
Mailing Address - Phone:877-471-9865
Mailing Address - Fax:803-335-5343
Practice Address - Street 1:208 CANDI LN STE B
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-8052
Practice Address - Country:US
Practice Address - Phone:877-471-9865
Practice Address - Fax:803-335-5343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-13
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use DisorderGroup - Multi-Specialty
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed ChildrenGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
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