Healthcare Provider Details

I. General information

NPI: 1437655453
Provider Name (Legal Business Name): FAMILYTIES OF SC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2018
Last Update Date: 03/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 E EVANS ST # 203
FLORENCE SC
29506-2511
US

IV. Provider business mailing address

5251 HUTTON CT
FLORENCE SC
29506-3466
US

V. Phone/Fax

Practice location:
  • Phone: 843-779-7525
  • Fax:
Mailing address:
  • Phone: 843-539-8438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: TENE WILLIAMS-GREEN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 843-779-7525