Provider Demographics
NPI:1245928423
Name:PALMETTO PSYCHOLOGICAL ASSOCIATES, LLC
Entity type:Organization
Organization Name:PALMETTO PSYCHOLOGICAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:INGRAM
Authorized Official - Last Name:SHANDS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:864-735-6880
Mailing Address - Street 1:832 WADE HAMPTON BLVD STE 211
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29609-4942
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:832 WADE HAMPTON BLVD STE 211
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29609-4942
Practice Address - Country:US
Practice Address - Phone:864-735-0604
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-26
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty