Healthcare Provider Details

I. General information

NPI: 1891569919
Provider Name (Legal Business Name): GENTLE STIX COLLECTION, TRAINING & MOBILE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2023
Last Update Date: 11/09/2023
Certification Date: 11/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3555 CAMDEN HWY STE 1
DALZELL SC
29040
US

IV. Provider business mailing address

3555 CAMDEN HWY STE 1
DALZELL SC
29040
US

V. Phone/Fax

Practice location:
  • Phone: 803-200-1557
  • Fax: 803-607-9276
Mailing address:
  • Phone: 803-200-1557
  • Fax: 803-607-9276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MRS. PIA C SIMMONS-EVANS
Title or Position: OWNER
Credential:
Phone: 803-200-1557