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General NPI Number Information
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NPI Number | 1790210169
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Entity Type | Organization
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Legal Business Name | SAFE HARBOR BEHAVIORAL HEALTH LLC
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Dates
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Enumeration Date | 04/24/2017
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Last Update Date | 04/24/2017
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Provider Practice Location Address
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Address Line | 302A MIDLAND PKWY
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City | SUMMERVILLE
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State | SC
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Zip | 29485-8102
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Country | US
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Telephone | 843-469-0935
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Fax | 509-479-4389
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Provider Business Mailing Address
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Address Line | 302A MIDLAND PKWY
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City | SUMMERVILLE
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State | SC
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Zip | 29485-8102
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Country | US
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Telephone |
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Fax | 509-479-4389
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Authorized Official
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Title or Position | OWNER, COUNSELOR
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Name | KIMBERLY REDDOUT
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Credential | MA, LPC
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Telephone | 843-469-0935
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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 | 6274
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License Number State | SC
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