Organization Name: | PHC SUPPORTIVE SERVICES LLC |
NPI Number: | 1073905378 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | GEROTHIA MCCULLOUGH (OWNER) |
Mailing Address: | 300 W Butler Rd Suite B Mauldin |
State: | SC US |
Postal Code: | 296622585 |
Phone Number: | 8644788688 |
Fax Number: | |
NPI Enumeration Date: | 02/23/2015 |
NPI Last Update Date: | 02/23/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 5544 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | SC |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |