Healthcare Provider Details

I. General information

NPI: 1285544981
Provider Name (Legal Business Name): NATHALIE FALLON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 N MAIN ST STE 209
ANDERSON SC
29621-3880
US

IV. Provider business mailing address

1380 APPLING DR UNIT 109
MOUNT PLEASANT SC
29464-4892
US

V. Phone/Fax

Practice location:
  • Phone: 864-633-4185
  • Fax:
Mailing address:
  • Phone: 404-444-2523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10828
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: