Healthcare Provider Details

I. General information

NPI: 1174915672
Provider Name (Legal Business Name): POSITIVE INFLUENCES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2015
Last Update Date: 02/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2716 W PALMETTO ST SUITE 4
FLORENCE SC
29501-5991
US

IV. Provider business mailing address

2716 W PALMETTO ST SUITE 4
FLORENCE SC
29501-5991
US

V. Phone/Fax

Practice location:
  • Phone: 843-799-5235
  • Fax:
Mailing address:
  • Phone: 843-799-5235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. TIFFANY DOWELL
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 843-799-5235