NPIMap

Organization Active NPI

Palmetto Counseling of Hartsville LLC

  • Professional Counselor
  • Hartsville, SC
National Provider Identifier
1619418779
Registry record updated Feb 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
5487 Issued in SC
Legal business name
PALMETTO COUNSELING OF HARTSVILLE LLC
Practice address
5003 Una Rd
Hartsville, SC 29550-1954
Phone
(843) 453-9985
NPI assigned
Mar 9, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2024

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

Authorized official

Name
Jill Suzanne Kelley, MANPI 1790814374
Title
LPC
Phone
(843) 307-4762

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YP2500X 5487 SC Primary

Addresses

Primary practice location

5003 Una Rd
Hartsville, SC 29550-1954

Mailing address

5003 Una Rd
Hartsville, SC 29550-1954
Phone (843) 453-9985

Other names 1

  • Palmetto Counseling of Hartsville, LLP Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240430000301 SC Part B Supplier - Clinic/Group Practice 5395185946 Receives reassigned benefits from 4 practitioners
Practice locations: Hartsville, SC

National Provider Directory

National Provider Directory

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1489017600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707696000000",
    "number": "1619418779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5003 UNA RD",
            "city": "HARTSVILLE",
            "state": "SC",
            "postal_code": "295501954",
            "telephone_number": "843-453-9985"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5003 UNA RD",
            "city": "HARTSVILLE",
            "state": "SC",
            "postal_code": "295501954",
            "telephone_number": "843-453-9985"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PALMETTO COUNSELING OF HARTSVILLE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-09",
        "last_updated": "2024-02-12",
        "certification_date": "2024-02-12",
        "status": "A",
        "authorized_official_last_name": "KELLEY",
        "authorized_official_first_name": "JILL",
        "authorized_official_middle_name": "SUZANNE",
        "authorized_official_title_or_position": "LPC",
        "authorized_official_telephone_number": "843-307-4762",
        "authorized_official_credential": "MA"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Professional",
            "state": "SC",
            "license": "5487",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Palmetto Counseling of Hartsville, LLP",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Hartsville, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.