| Provisions Counseling Services Llc | |
|
6 Executive Ct Lake Wylie SC 29710-9338 | |
| (704) 906-5558 | |
| Not Available |
| Full Name | Provisions Counseling Services Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 6 Executive Ct, Lake Wylie, South Carolina |
| Authorized Official Name and Position | Shiricka Lashaye Fair (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 7049065558 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Provisions Counseling Services Llc 5115 Mintvale Dr Charlotte NC 28269-1689 Ph: (704) 906-5558 | Provisions Counseling Services Llc 6 Executive Ct Lake Wylie SC 29710-9338 Ph: (704) 906-5558 |
| NPI Number | 1811371842 |
|---|---|
| Provider Enumeration Date | 07/20/2015 |
| Last Update Date | 07/20/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811371842 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 4611 (South Carolina) | Primary |
| 251S00000X | Community/behavioral Health | 1484 (North Carolina) | Secondary |
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