Provider Demographics
NPI:1194430967
Name:PALMETTO COMMUNITY GROUP OF NC, LLC
Entity type:Organization
Organization Name:PALMETTO COMMUNITY GROUP OF NC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-546-0313
Mailing Address - Street 1:402 NAUTIQUE CIR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-7334
Mailing Address - Country:US
Mailing Address - Phone:803-546-0313
Mailing Address - Fax:
Practice Address - Street 1:16101 WRIGHTS FERRY RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28278-7635
Practice Address - Country:US
Practice Address - Phone:803-546-0313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-17
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251B00000XAgenciesCase Management