Provider Demographics
NPI:1366183899
Name:LEADS WAY THERAPEUTIC SERVICES
Entity type:Organization
Organization Name:LEADS WAY THERAPEUTIC SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANTREANA
Authorized Official - Middle Name:ROMANDA
Authorized Official - Last Name:SINGLETON-GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-476-3260
Mailing Address - Street 1:186 DOGWOOD ST
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:SC
Mailing Address - Zip Code:29936-6112
Mailing Address - Country:US
Mailing Address - Phone:843-476-3260
Mailing Address - Fax:
Practice Address - Street 1:11382 N JACOB SMART BLVD STE D
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:SC
Practice Address - Zip Code:29936-2700
Practice Address - Country:US
Practice Address - Phone:843-441-9415
Practice Address - Fax:843-305-6107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-06
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251B00000XAgenciesCase ManagementGroup - Single Specialty
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity HealthGroup - Single Specialty
No261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-SurgicalGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Single Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No364SP0812XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, CommunityGroup - Single Specialty
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty