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General NPI Number Information
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NPI Number | 1316435852
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Entity Type | Organization
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Legal Business Name | SANKOFA YOUTH SERVICES, INC
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Dates
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Enumeration Date | 04/30/2018
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Last Update Date | 04/30/2018
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Provider Practice Location Address
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Address Line | 100 GATEWAY CORPORATE BLVD
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City | COLUMBIA
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State | SC
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Zip | 29203-9611
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Country | US
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Telephone | 980-213-9533
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Fax |
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Provider Business Mailing Address
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Address Line | 1131 HANNAH RAE CT
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City | CHARLOTTE
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State | NC
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Zip | 28214-1047
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Country | US
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Telephone | 980-213-9533
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Fax |
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Authorized Official
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Title or Position | CEO/FOUNDER
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Name | TARSHA WASHINGTON
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Credential | MA, LPC-I
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Telephone | 980-213-9533
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6568
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License Number State | SC
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