Healthcare Provider Details

I. General information

NPI: 1063055879
Provider Name (Legal Business Name): LEAN ON ME CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2019
Last Update Date: 05/02/2022
Certification Date: 05/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2166 GOLD HILL RD STE 4
FORT MILL SC
29708-9351
US

IV. Provider business mailing address

2166 GOLD HILL RD STE 4
FORT MILL SC
29708-9351
US

V. Phone/Fax

Practice location:
  • Phone: 803-973-0221
  • Fax: 803-973-0207
Mailing address:
  • Phone: 803-973-0221
  • Fax: 803-973-0207

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 Code146D00000X
TaxonomyPersonal Emergency Response Attendant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JEWELL THOMPSON
Title or Position: OWNER
Credential:
Phone: 803-973-0223