Provider Demographics
NPI:1053857102
Name:LOWCOUNTRY BRIDGES, LLC
Entity type:Organization
Organization Name:LOWCOUNTRY BRIDGES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:CARBONE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC/I, BCBA
Authorized Official - Phone:843-718-9922
Mailing Address - Street 1:2225 ASHLEY CROSSING DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-5852
Mailing Address - Country:US
Mailing Address - Phone:843-779-0167
Mailing Address - Fax:844-864-1700
Practice Address - Street 1:2225 ASHLEY CROSSING DR
Practice Address - Street 2:SUITE 102
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-5852
Practice Address - Country:US
Practice Address - Phone:843-779-0167
Practice Address - Fax:844-864-1700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-13
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCBL005424-12-2016252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency