Professional Intensive Outpatient Program of Florence

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

326 Issued in SC

Legal business name

PROFESSIONAL INTENSIVE OUTPATIENT PROGRAM OF FLORENCE

Practice address

323 S McQueen St
Florence, SC 29501-4722

Phone

(843) 673-0054

Fax

(843) 667-1549

NPI assigned

Feb 9, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. John Gary Martin, M.ED, LPC, LPCS

Title

Licensed Professional Counselor

Phone

(843) 673-0054

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170979200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214524800000",
    "number": "1184765653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "323 S MCQUEEN ST",
            "city": "FLORENCE",
            "state": "SC",
            "postal_code": "295014722",
            "telephone_number": "843-673-0054",
            "fax_number": "843-667-1549"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "323 S MCQUEEN ST",
            "city": "FLORENCE",
            "state": "SC",
            "postal_code": "295014722",
            "telephone_number": "843-673-0054",
            "fax_number": "843-667-1549"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL INTENSIVE OUTPATIENT PROGRAM OF FLORENCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-09",
        "last_updated": "2008-06-27",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "GARY",
        "authorized_official_title_or_position": "LICENSED PROFESSIONAL COUNSELOR",
        "authorized_official_telephone_number": "843-673-0054",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.ED, LPC, LPCS"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "SC",
            "license": "326",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.