Healthcare Provider Details

I. General information

NPI: 1992048029
Provider Name (Legal Business Name): THE TA NETWORK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2013
Last Update Date: 03/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1646 HARRIS CT
FLORENCE SC
29501-1545
US

IV. Provider business mailing address

1646 HARRIS CT
FLORENCE SC
29501-1545
US

V. Phone/Fax

Practice location:
  • Phone: 843-229-7413
  • Fax:
Mailing address:
  • Phone: 843-229-7413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. TERRY ALEXANDER
Title or Position: PASTOR
Credential: REV.
Phone: 843-229-7413