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General NPI Number Information
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NPI Number | 1689544512
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Entity Type | Organization
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Legal Business Name | LONGSHORE PSYCHIATRIC AND MENTAL HEALTH SERVICES
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Dates
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Enumeration Date | 11/06/2025
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Last Update Date | 11/06/2025
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Provider Practice Location Address
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Address Line | 60 N MAIN ST UNIT H
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City | HILTON HEAD ISLAND
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State | SC
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Zip | 29926-6603
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Country | US
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Telephone | 813-997-2099
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Fax |
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Provider Business Mailing Address
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Address Line | 60 N MAIN ST UNIT H
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City | HILTON HEAD ISLAND
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State | SC
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Zip | 29926-6603
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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 | ADMINISTRATOR
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Name | BRIAN CLUKIE
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Credential |
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Telephone | 813-997-2099
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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