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General NPI Number Information
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NPI Number | 1790351666
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Entity Type | Organization
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Legal Business Name | PALMETTO STATE PCIT, LLC
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Dates
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Enumeration Date | 06/01/2021
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Last Update Date | 06/17/2021
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Provider Practice Location Address
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Address Line | 26 HEARTWOOD CT
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City | BLUFFTON
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State | SC
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Zip | 29910-9560
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Country | US
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Telephone | 843-321-7107
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Fax | 843-326-4806
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Provider Business Mailing Address
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Address Line | 198 OKATIE VILLAGE DR STE 103-332
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City | OKATIE
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State | SC
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Zip | 29909-7527
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Country | US
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Telephone | 843-321-7107
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Fax | 843-326-4806
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Authorized Official
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Title or Position | FOUNDER/THERAPIST
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Name | ASHLEY BRATCHER
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Credential | LISW-CP
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Telephone | 843-321-7107
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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