| South Carolina Mentor | |
|
4 Carriage Ln Suite 302 Charleston SC 29407-6065 | |
| (843) 573-1905 | |
| (843) 573-1926 |
| Full Name | South Carolina Mentor |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 4 Carriage Ln, Charleston, South Carolina |
| Authorized Official Name and Position | Jennifer Mary Poole (BEHAVIORAL CONSULTANT) |
| Authorized Official Contact | 8435130040 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| South Carolina Mentor 4 Carriage Ln Suite 302 Charleston SC 29407-6065 Ph: (843) 573-1905 | South Carolina Mentor 4 Carriage Ln Suite 302 Charleston SC 29407-6065 Ph: (843) 573-1905 |
| NPI Number | 1972845196 |
|---|---|
| Provider Enumeration Date | 03/26/2013 |
| Last Update Date | 03/26/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972845196 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 1-13-12976 (South Carolina) | Primary |
| 252Y00000X | Early Intervention Provider Agency | 1-13-12976 (South Carolina) | Secondary |
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