Healthcare Provider Details

I. General information

NPI: 1205670122
Provider Name (Legal Business Name): UPSTATE PSYCHIATRIC CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2024
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4120 CLEMSON BLVD STE I
ANDERSON SC
29621-1176
US

IV. Provider business mailing address

713 E GREENVILLE ST STE D
ANDERSON SC
29621-4838
US

V. Phone/Fax

Practice location:
  • Phone: 864-964-7600
  • Fax:
Mailing address:
  • Phone: 864-964-7600
  • Fax: 864-964-7700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. VIOLETA NISTOR
Title or Position: OWNER
Credential: MD
Phone: 864-964-7600