| St. Andrews Psychiatric Services, Llc | |
|
669 Saint Andrews Blvd Charleston SC 29407-7165 | |
| (843) 367-2716 | |
| (843) 556-0300 |
| Full Name | St. Andrews Psychiatric Services, Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 669 Saint Andrews Blvd, Charleston, South Carolina |
| Authorized Official Name and Position | Darlene H Moak (OWNER / MEMBER) |
| Authorized Official Contact | 8433272716 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| St. Andrews Psychiatric Services, Llc 669 Saint Andrews Blvd Charleston SC 29407-7165 Ph: (843) 367-2716 | St. Andrews Psychiatric Services, Llc 669 Saint Andrews Blvd Charleston SC 29407-7165 Ph: (843) 367-2716 |
| NPI Number | 1922039940 |
|---|---|
| Provider Enumeration Date | 07/06/2006 |
| Last Update Date | 11/30/2007 |
| Medicare PECOS PAC ID | 2163480641 |
|---|---|
| Medicare Enrollment ID | O20041230000199 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922039940 | NPI | - | NPPES |
| GP4054 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Darlene Harriett Moak |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1659323830 PECOS PAC ID: 3870551351 Enrollment ID: I20050103000023 |
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