| Ernest Kennedy Center | |
|
96 Wisteria Rd Goose Creek SC 29445-3495 | |
| (843) 867-6132 | |
| Not Available |
| Full Name | Ernest Kennedy Center |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 96 Wisteria Rd, Goose Creek, South Carolina |
| Authorized Official Name and Position | Jerome Tilghman (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 8437193001 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ernest Kennedy Center 306 Airport Dr Moncks Corner SC 29461-2629 Ph: () - | Ernest Kennedy Center 96 Wisteria Rd Goose Creek SC 29445-3495 Ph: (843) 867-6132 |
| NPI Number | 1982217246 |
|---|---|
| Provider Enumeration Date | 08/26/2020 |
| Last Update Date | 08/26/2020 |
| Certification Date | 08/26/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982217246 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Primary |
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