MEDICARE: UPSTATE CAROLINA AUTISM ASSOCIATES 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	:	1912861808
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UPSTATE CAROLINA AUTISM ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	402 E 1ST AVE
Second Line	:
City	:	EASLEY
State	:	SC
Zip	:	29640-3063
Country	:	US
Telephone Number	:	864-835-8409
Fax Number	:

Provider Business Practice Location Address
First Line	:	402 E 1ST AVE
Second Line	:
City	:	EASLEY
State	:	SC
Zip	:	29640-3063
Country	:	US
Telephone Number	:	864-835-8409
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TOSHA ROLLINS
Credential	:	LPC
Telephone Number	:	864-835-8409

Provider Enumeration Date	:	12/15/2025
Last Update Date	:	12/15/2025

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