Healthcare Provider Details

I. General information

NPI: 1639763576
Provider Name (Legal Business Name): PINNACLE FAMILY SERVICES OF SOUTH CAROLINA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2021
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 WESTPARK BLVD STE 140
COLUMBIA SC
29210-3871
US

IV. Provider business mailing address

3117 POPLARWOOD CT STE 350
RALEIGH NC
27604-6446
US

V. Phone/Fax

Practice location:
  • Phone: 919-790-8580
  • Fax:
Mailing address:
  • Phone: 919-790-8580
  • 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 Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: PRESTON SCOTT MARTIN
Title or Position: COO
Credential:
Phone: 919-790-8580