NPIMap

Organization Active NPI

Driftwood Evaluation Center, LLC

  • School Psychologist
  • Summerville, SC
National Provider Identifier
1669135125
Registry record updated Jan 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
School PsychologistTaxonomy code 103TS0200X
Legal business name
DRIFTWOOD EVALUATION CENTER, LLC
Practice address
1815 Bacons Bridge Rd Apt B12
Summerville, SC 29485-3258
Phone
(843) 209-7832
NPI assigned
Oct 20, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 2, 2023

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

Authorized official

Name
Dr. Andrew Preston, PHDNPI 1790096436
Title
Clinical Director
Phone
(843) 376-3112

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
School PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TS0200X Primary

Addresses

Primary practice location

1815 Bacons Bridge Rd Apt B12
Summerville, SC 29485-3258

Mailing address

10070 Dorchester Rd Unit 50017
Summerville, SC 29485-2507
Phone (843) 376-3112

Other identifiers 2

IdentifierTypeStateIssuer
PG0662MedicaidSC
LP1002MedicaidSC

National Provider Directory

National Provider Directory

Locations

10070 Dorchester Rd
Unit 50017
Summerville, SC 29485

Practitioners & affiliated clinicians

Practitioners 5

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": "1634688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1672617600000",
    "number": "1669135125",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10070 DORCHESTER RD UNIT 50017",
            "city": "SUMMERVILLE",
            "state": "SC",
            "postal_code": "294852507",
            "telephone_number": "843-376-3112",
            "fax_number": "843-594-0110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1815 BACONS BRIDGE RD APT B12",
            "city": "SUMMERVILLE",
            "state": "SC",
            "postal_code": "294853258",
            "telephone_number": "843-209-7832"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DRIFTWOOD EVALUATION CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-20",
        "last_updated": "2023-01-02",
        "certification_date": "2023-01-02",
        "status": "A",
        "authorized_official_last_name": "PRESTON",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "843-376-3112",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103TS0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, School",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PG0662",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LP1002",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Summerville, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2023; 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.