Healthcare Provider Details

I. General information

NPI: 1629908900
Provider Name (Legal Business Name): LAUREN VITEK
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 CLEBOURNE ST
FORT MILL SC
29715-1753
US

IV. Provider business mailing address

182 BASILDON ST
LANCASTER SC
29720-6137
US

V. Phone/Fax

Practice location:
  • Phone: 704-931-1010
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10948
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: