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General NPI Number Information
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NPI Number | 1790067973
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Entity Type | Organization
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Legal Business Name | CAROLINA YOUTH SERVICES
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Dates
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Enumeration Date | 09/14/2011
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Last Update Date | 09/19/2011
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Provider Practice Location Address
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Address Line | 2150 SPOLATO LN E
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City | CHARLESTON
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State | SC
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Zip | 29406
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Country | US
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Telephone | 843-452-0268
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Fax |
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Provider Business Mailing Address
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Address Line | 101 TEA OLIVE CT
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City | SUMMERVILLE
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State | SC
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Zip | 29485
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Country | US
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Telephone | 843-452-0268
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | RONALD WITHERSPOON
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Credential | M.A.
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Telephone | 843-452-0268
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LIC-5-11-62510
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License Number State | SC
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