Healthcare Provider Details

I. General information

NPI: 1043432180
Provider Name (Legal Business Name): PALMETTO FAMILY WORKS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 08/01/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2135 HOFFMEYER RD STE B
FLORENCE SC
29501-4087
US

IV. Provider business mailing address

887 NE MAIN ST STE C
SIMPSONVILLE SC
29681-2041
US

V. Phone/Fax

Practice location:
  • Phone: 843-615-2770
  • Fax: 864-228-7247
Mailing address:
  • Phone: 843-615-2770
  • Fax: 864-228-7247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4156
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER F ELKINS
Title or Position: OWNER
Credential: LPC
Phone: 843-615-2770