| Professional Addiction Services Llc | |
|
133 E 1st North St Summerville SC 29483-6873 | |
| (254) 760-9610 | |
| Not Available |
| Full Name | Professional Addiction Services Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 133 E 1st North St, Summerville, South Carolina |
| Authorized Official Name and Position | Kathleen Waters (OWNER) |
| Authorized Official Contact | 2547609603 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Professional Addiction Services Llc 306 Brick Kiln Dr Summerville SC 29483-5415 Ph: (254) 760-9603 | Professional Addiction Services Llc 133 E 1st North St Summerville SC 29483-6873 Ph: (254) 760-9610 |
| NPI Number | 1922583277 |
|---|---|
| Provider Enumeration Date | 10/02/2018 |
| Last Update Date | 10/04/2018 |
| Medicare PECOS PAC ID | 5597000638 |
|---|---|
| Medicare Enrollment ID | O20181218003674 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922583277 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Kathleen Anne Waters |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295028959 PECOS PAC ID: 1355511049 Enrollment ID: I20110908001596 |
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