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General NPI Number Information
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NPI Number | 1285901660
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Entity Type | Organization
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Legal Business Name | NEXT GENERATION FAMILY AND YOUTH SERVICES LLC
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Dates
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Enumeration Date | 11/29/2011
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Last Update Date | 01/24/2012
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Provider Practice Location Address
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Address Line | 1956 THURGOOD MARSHALL HWY STE. 2
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City | KINGSTREE
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State | SC
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Zip | 29556-5583
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Country | US
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Telephone | 843-245-7202
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Fax |
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Provider Business Mailing Address
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Address Line | 1956 THURGOOD MARSHALL HWY STE. 2
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City | KINGSTREE
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State | SC
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Zip | 29556-5583
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PROVIDER
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Name | CHAD BURGESS
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Credential |
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Telephone | 843-245-7202
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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