Healthcare Provider Details

I. General information

NPI: 1063331353
Provider Name (Legal Business Name): DOVE MEADOW THERAPY CO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

669 MARINA DR STE B6
CHARLESTON SC
29492-8120
US

IV. Provider business mailing address

416 GIANNA LN
GOOSE CREEK SC
29445-3672
US

V. Phone/Fax

Practice location:
  • Phone: 781-291-1286
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: EMMA LEE RUSH
Title or Position: LCSW
Credential: LCSW
Phone: 781-291-1286