864pride
Clinic/Center, Mental Health (Including Community Mental Health Center) in Greenville, SC. Organization (NPI-2).
NPI number1790481422
StatusActive
Last updated in NPPESFeb 3, 2023
Details
- NPI
- 1790481422
- Entity type
- Organization (NPI-2)
- Legal business name
- 864pride
- Organization subpart
- No
- Enumeration date
- Feb 3, 2023
- Certification date
- Feb 3, 2023
- Last updated
- Feb 3, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QM0801X | Clinic/Center, Mental Health (Including Community Mental Health Center) | – | – | Yes |
Practice location
30 Pointe CirGreenville, SC 29615-3506
Phone 864-655-5193 · Fax 864-655-5183
Mailing address
30 Pointe CirGreenville, SC 29615-3506
Phone 864-325-1356 · Fax 864-655-5183
Authorized official
Laura Davis
President
8643251356
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