Basic Information
| Provider Information | |||||||||
| NPI: | 1053481507 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PALMETTO BEHAVORIAL HEALTH SOLUTIONS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2900 EVATT LN STE 106 | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294058700 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2900 EVATT LN STE 106 | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294058700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437455153 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | PEREZ | ||||||||
| AuthorizedOfficialFirstName: | CHLOE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHILD AND ADOLESCENT THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 8437455153 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 7381 | SC | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.