Provider Demographics
NPI:1184082604
Name:U-REAACH, LLC
Entity type:Organization
Organization Name:U-REAACH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAMIEN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LPC, CAC-II,
Authorized Official - Phone:843-586-0108
Mailing Address - Street 1:741 CRAIG CIR
Mailing Address - Street 2:
Mailing Address - City:BENNETTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29512-2005
Mailing Address - Country:US
Mailing Address - Phone:843-586-0108
Mailing Address - Fax:843-586-0108
Practice Address - Street 1:104 RED BLUFF STREET
Practice Address - Street 2:
Practice Address - City:CLIO
Practice Address - State:SC
Practice Address - Zip Code:29525-4722
Practice Address - Country:US
Practice Address - Phone:843-586-0108
Practice Address - Fax:843-586-0108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-29
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1411038101YA0400X
SC5249101YM0800X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty