Healthcare Provider Details

I. General information

NPI: 1861319642
Provider Name (Legal Business Name): EMBER WILLOW THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 REMOUNT RD
NORTH CHARLESTON SC
29406-3234
US

IV. Provider business mailing address

1615 REMOUNT RD
NORTH CHARLESTON SC
29406-3234
US

V. Phone/Fax

Practice location:
  • Phone: 843-543-3682
  • Fax:
Mailing address:
  • Phone: 843-543-3682
  • 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: ELIZABETH ALLEN
Title or Position: CO-OWNER
Credential:
Phone: 843-543-3682