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General NPI Number Information
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NPI Number | 1053857102
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Entity Type | Organization
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Legal Business Name | LOWCOUNTRY BRIDGES, LLC
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Dates
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Enumeration Date | 01/13/2017
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Last Update Date | 01/13/2017
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Provider Practice Location Address
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Address Line | 2225 ASHLEY CROSSING DR SUITE 102
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City | CHARLESTON
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State | SC
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Zip | 29414-5852
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Country | US
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Telephone | 843-779-0167
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Fax | 844-864-1700
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Provider Business Mailing Address
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Address Line | 2225 ASHLEY CROSSING DR SUITE 102
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City | CHARLESTON
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State | SC
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Zip | 29414-5852
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Country | US
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Telephone | 843-779-0167
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Fax | 844-864-1700
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | CATHERINE M CARBONE
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Credential | LPC/I, BCBA
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Telephone | 843-718-9922
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | BL005424-12-2016
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License Number State | SC
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