Healthcare Provider Details

I. General information

NPI: 1912577982
Provider Name (Legal Business Name): THE FAMILY CENTER OF AIKEN COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2021
Last Update Date: 06/30/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1117 GEORGIA AVE
NORTH AUGUSTA SC
29841-3012
US

IV. Provider business mailing address

1117 GEORGIA AVE
NORTH AUGUSTA SC
29841-3012
US

V. Phone/Fax

Practice location:
  • Phone: 803-752-0404
  • Fax: 888-384-2250
Mailing address:
  • Phone: 803-752-0404
  • Fax: 888-384-2250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. EDGAR JOE HOLT
Title or Position: CEO/CLINICAL DIRECTOR
Credential: PHD
Phone: 803-752-0404