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NPI Code Detail

MEDICARE: THE ERNEST E KENNEDY CENTER

MEDICARE: THE ERNEST E KENNEDY CENTER
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
1251S00000XCommunity/Behavioral Health AgencySC

General Provider Information

NPI Number : 1639493828
Entity Type Code : Organization
Provider Name (Legal Business Name) : THE ERNEST E KENNEDY CENTER
Provider Business Mailing Address
First Line : 96 WISTERIA RD
Second Line :
City : GOOSE CREEK
State : SC
Zip : 29445-3495
Country : US
Telephone Number : 843-797-7871
Fax Number :
Provider Business Practice Location Address
First Line : 96 WISTERIA RD
Second Line :
City : GOOSE CREEK
State : SC
Zip : 29445-3495
Country : US
Telephone Number : 843-797-7871
Fax Number :
Authorized Official
Title or Position : CLINICAL COUNSELOR
Name : MS. PORCHER WASHINGTON
Credential : M.A. CACII
Telephone Number : 843-797-7871
Provider Enumeration Date : 03/17/2010
Last Update Date : 03/17/2010

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Directions to “THE ERNEST E KENNEDY CENTER ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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