Provider Demographics
NPI:1427130533
Name:ADOLESCENT AND FAMILY SERVICES, P.A.
Entity type:Organization
Organization Name:ADOLESCENT AND FAMILY SERVICES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:E
Authorized Official - Last Name:MARTINSON
Authorized Official - Suffix:
Authorized Official - Credentials:MED LPC/S CCS
Authorized Official - Phone:864-250-9939
Mailing Address - Street 1:25 WOODS LAKE RD
Mailing Address - Street 2:SUITE 508
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-6125
Mailing Address - Country:US
Mailing Address - Phone:864-250-9939
Mailing Address - Fax:864-250-9939
Practice Address - Street 1:25 WOODS LAKE RD
Practice Address - Street 2:SUITE 508
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-6125
Practice Address - Country:US
Practice Address - Phone:864-250-9939
Practice Address - Fax:864-250-9939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3469251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health