MEDICARE: MOSAIC MILESTONES CHILD AND FAMILY THERAPY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1659219053
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOSAIC MILESTONES CHILD AND FAMILY THERAPY LLC

Provider Business Mailing Address
First Line	:	414 BRANCH CREEK TRL
Second Line	:
City	:	SUMMERVILLE
State	:	SC
Zip	:	29483-5265
Country	:	US
Telephone Number	:	704-914-6586
Fax Number	:

Provider Business Practice Location Address
First Line	:	414 BRANCH CREEK TRL
Second Line	:
City	:	SUMMERVILLE
State	:	SC
Zip	:	29483-5265
Country	:	US
Telephone Number	:	704-914-6586
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TABITHA RUE STRONG
Credential	:	PLC
Telephone Number	:	704-914-6586

Provider Enumeration Date	:	03/24/2026
Last Update Date	:	03/24/2026

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