MEDICARE: STEP BY STEP, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1295175735
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEP BY STEP, LLC

Provider Business Mailing Address
First Line	:	2426 STADIUM DR
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406-6600
Country	:	US
Telephone Number	:	843-303-8803
Fax Number	:

Provider Business Practice Location Address
First Line	:	2426 STADIUM DR
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406-6600
Country	:	US
Telephone Number	:	843-303-8803
Fax Number	:

Authorized Official
Title or Position	:	PRINCIPLE
Name	:	ROBIN NICOLE MACK
Credential	:	MA
Telephone Number	:	843-303-8803

Provider Enumeration Date	:	06/28/2013
Last Update Date	:	06/28/2013

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