NPIMap

Organization Active NPI

Charleston Family Center, LLC

  • Marriage & Family Therapist
  • Charleston, SC
National Provider Identifier
1619939873
Registry record updated Feb 23, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
6767 Issued in SC
Legal business name
CHARLESTON FAMILY CENTER, LLC
Practice address
4 Carriage LN
Suite 100
Charleston, SC 29407-6048
Phone
(843) 763-2222
Fax
(843) 766-5705
NPI assigned
Apr 4, 2006
Last updated
Feb 23, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2008

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

Authorized official

Name
Mrs. Joan Berry
Title
Office Manager
Phone
(843) 763-2222

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X 6767 SC Primary

Addresses

Primary practice location

4 Carriage LN
Suite 100
Charleston, SC 29407-6048

Mailing address

4 Carriage LN
Suite 100
Charleston, SC 29407-6048
Phone (843) 763-2222

Other identifiers 2

IdentifierTypeStateIssuer
GP3347MedicaidSC
DG5930OtherSCRR MEDICARE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040504000681 SC Part B Supplier - Clinic/Group Practice 3274521703 Receives reassigned benefits from 2 practitioners
Practice locations: Charleston, SC; Walterboro, SC

National Provider Directory

National Provider Directory
Tax ID family
Charleston Family Center LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

303 Maxey St
Walterboro, SC 29488
Phone (843) 549-7664

Practitioners & affiliated clinicians

Practitioners 22

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1144108800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1203724800000",
    "number": "1619939873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 CARRIAGE LN",
            "address_2": "SUITE 100",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294076048",
            "telephone_number": "843-763-2222",
            "fax_number": "843-766-5705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 CARRIAGE LN",
            "address_2": "SUITE 100",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294076048",
            "telephone_number": "843-763-2222",
            "fax_number": "843-766-5705"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLESTON FAMILY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-04",
        "last_updated": "2008-02-23",
        "status": "A",
        "authorized_official_last_name": "BERRY",
        "authorized_official_first_name": "JOAN",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "843-763-2222",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "SC",
            "license": "6767",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP3347",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "DG5930",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charleston, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2008; 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.