Healthcare Provider Details

I. General information

NPI: 1912672296
Provider Name (Legal Business Name): TOTAL CARE PSYCHIATRY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2021
Last Update Date: 08/10/2021
Certification Date: 08/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 GUILFORD DR
EASLEY SC
29642-8626
US

IV. Provider business mailing address

1027 S PENDLETON ST # 336
EASLEY SC
29642-1046
US

V. Phone/Fax

Practice location:
  • Phone: 843-276-2019
  • Fax:
Mailing address:
  • Phone: 843-276-2019
  • Fax: 864-671-6007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. LEILANI LEE
Title or Position: CEO
Credential: MD
Phone: 843-276-2019