| 864pride | |
|
30 Pointe Cir Greenville SC 29615-3506 | |
| (864) 655-5193 | |
| (864) 655-5183 |
| Full Name | 864pride |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 30 Pointe Cir, Greenville, South Carolina |
| Authorized Official Name and Position | Laura Davis (PRESIDENT) |
| Authorized Official Contact | 8643251356 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| 864pride 30 Pointe Cir Greenville SC 29615-3506 Ph: (864) 325-1356 | 864pride 30 Pointe Cir Greenville SC 29615-3506 Ph: (864) 655-5193 |
| NPI Number | 1790481422 |
|---|---|
| Provider Enumeration Date | 02/03/2023 |
| Last Update Date | 02/03/2023 |
| Certification Date | 02/03/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790481422 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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