Healthcare Provider Details

I. General information

NPI: 1467981688
Provider Name (Legal Business Name): PARTRIDGE FAMILY COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2017
Last Update Date: 05/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1335 44TH AVE N STE 103
MYRTLE BEACH SC
29577
US

IV. Provider business mailing address

235 SUGAR MILL LOOP
MYRTLE BEACH SC
29588-4631
US

V. Phone/Fax

Practice location:
  • Phone: 843-236-6036
  • Fax:
Mailing address:
  • Phone: 843-236-6036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HEATHER PARTRIDGE
Title or Position: OWNER
Credential:
Phone: 843-236-6036