Healthcare Provider Details

I. General information

NPI: 1689536450
Provider Name (Legal Business Name): IMPACTWORKS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 THORNBY RD
IRMO SC
29063-9129
US

IV. Provider business mailing address

113 THORNBY RD
IRMO SC
29063-9129
US

V. Phone/Fax

Practice location:
  • Phone: 839-273-0143
  • Fax:
Mailing address:
  • Phone: 839-273-0143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: LUCAS DEMONTE
Title or Position: OWNER/THERAPIST/CONSULTANT
Credential: LCMHC,LMHC, LPC, NCC
Phone: 839-273-0143