| Life Skills Community Center Inc | |
|
3575 Rutherford Road Ext Ste B Taylors SC 29687-2168 | |
| (404) 918-0908 | |
| Not Available |
| Full Name | Life Skills Community Center Inc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 3575 Rutherford Road Ext Ste B, Taylors, South Carolina |
| Authorized Official Name and Position | Keeth Miller (OWNER/CEO) |
| Authorized Official Contact | 4049180908 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Life Skills Community Center Inc 4925 Erin Rd Sw Atlanta GA 30331-7808 Ph: (404) 918-0908 | Life Skills Community Center Inc 3575 Rutherford Road Ext Ste B Taylors SC 29687-2168 Ph: (404) 918-0908 |
| NPI Number | 1871100024 |
|---|---|
| Provider Enumeration Date | 09/30/2020 |
| Last Update Date | 09/18/2024 |
| Certification Date | 09/18/2024 |
| Medicare PECOS PAC ID | 4981110707 |
|---|---|
| Medicare Enrollment ID | O20250718003781 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871100024 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | () | Secondary |
| 251B00000X | Case Management | () | Secondary |
| 251S00000X | Community/behavioral Health | () | Primary |
| Provider Name | Anita Blandena Brown |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1699012393 PECOS PAC ID: 3173039831 Enrollment ID: I20250720000148 |
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