Healthcare Provider Details

I. General information

NPI: 1700567377
Provider Name (Legal Business Name): SOLID ROCK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2023
Last Update Date: 07/27/2023
Certification Date: 07/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 BW THOMAS DR STE 108
FORT MILL SC
29708-7230
US

IV. Provider business mailing address

PO BOX 43531
CHARLOTTE NC
28215-0040
US

V. Phone/Fax

Practice location:
  • Phone: 704-777-6132
  • Fax:
Mailing address:
  • Phone: 980-213-9471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: TONYA BUTLER
Title or Position: OWNER
Credential:
Phone: 980-213-9471