Healthcare Provider Details

I. General information

NPI: 1619795713
Provider Name (Legal Business Name): NEW LAND THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2024
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1816 MEPKIN RD
CHARLESTON SC
29407-3036
US

IV. Provider business mailing address

PO BOX 80028
CHARLESTON SC
29416-0028
US

V. Phone/Fax

Practice location:
  • Phone: 843-471-0807
  • Fax:
Mailing address:
  • Phone: 843-471-0807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: ZORYANA KAKHNOVETS
Title or Position: OWNER
Credential: MA
Phone: 843-471-0807