Provider Demographics
NPI:1518625441
Name:CHARLESTON MEDICINE AND BEHAVIORAL HEALTH, LLC
Entity type:Organization
Organization Name:CHARLESTON MEDICINE AND BEHAVIORAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:RODNEY
Authorized Official - Last Name:ANDREWS
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:843-913-8558
Mailing Address - Street 1:PO BOX 13689
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29422-3689
Mailing Address - Country:US
Mailing Address - Phone:843-913-8558
Mailing Address - Fax:843-284-9558
Practice Address - Street 1:125 WAPPOO CREEK DR STE 202A
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-5100
Practice Address - Country:US
Practice Address - Phone:843-913-8858
Practice Address - Fax:843-284-9558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-08
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service