Provider Demographics
NPI:1669135125
Name:DRIFTWOOD EVALUATION CENTER, LLC
Entity type:Organization
Organization Name:DRIFTWOOD EVALUATION CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:PRESTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:843-376-3112
Mailing Address - Street 1:10070 DORCHESTER RD UNIT 50017
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-2507
Mailing Address - Country:US
Mailing Address - Phone:843-376-3112
Mailing Address - Fax:843-594-0110
Practice Address - Street 1:1815 BACONS BRIDGE RD APT B12
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-3258
Practice Address - Country:US
Practice Address - Phone:843-209-7832
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-20
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPG0662Medicaid
SCLP1002Medicaid