Healthcare Provider Details

I. General information

NPI: 1871986158
Provider Name (Legal Business Name): PALMETTO FAMILY SERVICE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2015
Last Update Date: 03/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2638 TWO NOTCH RD STE 108
COLUMBIA SC
29204-1454
US

IV. Provider business mailing address

2638 TWO NOTCH RD STE 108
COLUMBIA SC
29204-1454
US

V. Phone/Fax

Practice location:
  • Phone: 803-779-7257
  • Fax: 803-779-5285
Mailing address:
  • Phone: 803-779-7257
  • Fax: 803-779-5285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateSC

VIII. Authorized Official

Name: CARMEN HAMPTON JULIOUS
Title or Position: CEO
Credential: LISW-CP&AP
Phone: 803-779-7257