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448 Lakeshore Pkwy Suite 205 Rock Hill SC 29730-4264 | |
| (803) 328-9600 | |
| (803) 329-7141 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 448 Lakeshore Pkwy, Rock Hill, South Carolina |
| Authorized Official Name and Position | Tracy L Turner (CONTROLLER) |
| Authorized Official Contact | 8038988503 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
448 Lakeshore Pkwy Suite 205 Rock Hill SC 29730-4264 Ph: (803) 328-9600 | 448 Lakeshore Pkwy Suite 205 Rock Hill SC 29730-4264 Ph: (803) 328-9600 |
| NPI Number | 1568476885 |
|---|---|
| Provider Enumeration Date | 07/29/2006 |
| Last Update Date | 09/20/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568476885 | NPI | - | NPPES |
| 342725 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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