Healthcare Provider Details

I. General information

NPI: 1578133781
Provider Name (Legal Business Name): THERAPY RESOURCE GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2021
Last Update Date: 05/09/2022
Certification Date: 05/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 SPRATT ST STE B
FORT MILL SC
29715-4111
US

IV. Provider business mailing address

117 SPRATT ST STE B
FORT MILL SC
29715-4111
US

V. Phone/Fax

Practice location:
  • Phone: 704-931-1010
  • Fax:
Mailing address:
  • Phone: 704-931-1010
  • 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 Code310500000X
TaxonomyMental Illness Intermediate Care Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. NICOLE FOSTER GASKINS
Title or Position: DIRECTOR/CLINICIAN
Credential: M.ED, LPC, LCMHCA
Phone: 704-931-1010