Provider Demographics
NPI:1619845633
Name:SOARING MINDS EVALUATIONS AND SUPPORT
Entity type:Organization
Organization Name:SOARING MINDS EVALUATIONS AND SUPPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHO-ED SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:JACQUILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:GAITHER
Authorized Official - Suffix:
Authorized Official - Credentials:EDS, LPES
Authorized Official - Phone:843-474-6560
Mailing Address - Street 1:281 PEMBERLY BLVD
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29486-7780
Mailing Address - Country:US
Mailing Address - Phone:412-719-4839
Mailing Address - Fax:
Practice Address - Street 1:281 PEMBERLY BLVD
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29486-7780
Practice Address - Country:US
Practice Address - Phone:843-474-6560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-29
Last Update Date:2025-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Single Specialty