Provider Demographics
NPI:1528496791
Name:BYRD'S OF A FEATHER THERAPEUTIC AFTERSCHOOL PROGRAM & COMMUNITY ARTS
Entity type:Organization
Organization Name:BYRD'S OF A FEATHER THERAPEUTIC AFTERSCHOOL PROGRAM & COMMUNITY ARTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:SUZETTE
Authorized Official - Middle Name:MONIQUE
Authorized Official - Last Name:BYRD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-414-0747
Mailing Address - Street 1:1087 LAWRENCE RD
Mailing Address - Street 2:
Mailing Address - City:CLOVER
Mailing Address - State:SC
Mailing Address - Zip Code:29710-9795
Mailing Address - Country:US
Mailing Address - Phone:803-414-0747
Mailing Address - Fax:
Practice Address - Street 1:401 KINGS MOUNTAIN ST
Practice Address - Street 2:
Practice Address - City:CLOVER
Practice Address - State:SC
Practice Address - Zip Code:29710-1217
Practice Address - Country:US
Practice Address - Phone:803-414-0747
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-24
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty