Healthcare Provider Details

I. General information

NPI: 1437060902
Provider Name (Legal Business Name): VESSEL OF DISCOVERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1639 WINDSONG FOREST RD
CLOVER SC
29710-9410
US

IV. Provider business mailing address

1639 WINDSONG FOREST RD
CLOVER SC
29710-9410
US

V. Phone/Fax

Practice location:
  • Phone: 803-627-0249
  • Fax:
Mailing address:
  • Phone: 803-627-0249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DIANA KICKERY
Title or Position: OWNER/THERAPIST
Credential: LISW-CP
Phone: 803-627-0249