Healthcare Provider Details

I. General information

NPI: 1508385469
Provider Name (Legal Business Name): PALMETTO COMMUNITY GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2017
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 OFFICE PARK CT STE F
COLUMBIA SC
29223-5965
US

IV. Provider business mailing address

402 NAUTIQUE CIR
COLUMBIA SC
29229-7334
US

V. Phone/Fax

Practice location:
  • Phone: 803-636-7951
  • Fax:
Mailing address:
  • Phone: 803-546-0313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4993
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: NATASHA R BRANON
Title or Position: OWNER
Credential: LPC
Phone: 803-636-7951