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General NPI Number Information
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NPI Number | 1619939873
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Entity Type | Organization
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Legal Business Name | CHARLESTON FAMILY CENTER, LLC
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Dates
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Enumeration Date | 04/04/2006
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Last Update Date | 02/23/2008
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Provider Practice Location Address
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Address Line | 4 CARRIAGE LN SUITE 100
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City | CHARLESTON
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State | SC
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Zip | 29407-6048
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Country | US
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Telephone | 843-763-2222
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Fax | 843-766-5705
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Provider Business Mailing Address
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Address Line | 4 CARRIAGE LN SUITE 100
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City | CHARLESTON
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State | SC
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Zip | 29407-6048
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Country | US
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Telephone | 843-763-2222
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Fax | 843-766-5705
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. JOAN BERRY
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Credential |
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Telephone | 843-763-2222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 6767
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License Number State | SC
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