Healthcare Provider Details

I. General information

NPI: 1639604929
Provider Name (Legal Business Name): LOWCOUNTRY WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2017
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1565 SAM RITTENBERG BLVD STE 201
CHARLESTON SC
29407-4138
US

IV. Provider business mailing address

1565 SAM RITTENBERG BLVD STE 201
CHARLESTON SC
29407-4138
US

V. Phone/Fax

Practice location:
  • Phone: 843-793-1353
  • Fax: 843-818-4172
Mailing address:
  • Phone: 843-793-1353
  • Fax: 843-818-4172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. PENELOPE LYNN VACHON
Title or Position: MEMBER
Credential: APRN
Phone: 843-793-1353