Healthcare Provider Details

I. General information

NPI: 1831036888
Provider Name (Legal Business Name): MAMA T HERBS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 SNOWY CT
FOUNTAIN INN SC
29644-6176
US

IV. Provider business mailing address

2607 WOODRUFF RD STE E
SIMPSONVILLE SC
29681-3625
US

V. Phone/Fax

Practice location:
  • Phone: 864-747-2836
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name: TRELA RENE PETERS
Title or Position: DOULA
Credential:
Phone: 864-747-2836