| Southeastern Success Center, Llc | |
|
911 Lyttleton St Camden SC 29020-4412 | |
| (803) 713-7979 | |
| (803) 728-2200 |
| Full Name | Southeastern Success Center, Llc |
|---|---|
| Speciality | Counselor |
| Location | 911 Lyttleton St, Camden, South Carolina |
| Authorized Official Name and Position | Mary Myers Bridges (OWNER) |
| Authorized Official Contact | 8037137979 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southeastern Success Center, Llc Po Box 2487 Camden SC 29020-8009 Ph: (803) 729-5161 | Southeastern Success Center, Llc 911 Lyttleton St Camden SC 29020-4412 Ph: (803) 713-7979 |
| NPI Number | 1659800167 |
|---|---|
| Provider Enumeration Date | 06/08/2017 |
| Last Update Date | 10/06/2023 |
| Certification Date | 10/06/2023 |
| Medicare PECOS PAC ID | 6608214242 |
|---|---|
| Medicare Enrollment ID | O20240402003111 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659800167 | NPI | - | NPPES |
| Provider Name | Mary Myers Bridges |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1760808570 PECOS PAC ID: 7517305162 Enrollment ID: I20240403000072 |
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