Healthcare Provider Details

I. General information

NPI: 1245961374
Provider Name (Legal Business Name): PURPOSEFUL WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2022
Last Update Date: 06/20/2022
Certification Date: 06/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

523 BOULDER CT
GRANITEVILLE SC
29829-6018
US

IV. Provider business mailing address

523 BOULDER CT
GRANITEVILLE SC
29829-6018
US

V. Phone/Fax

Practice location:
  • Phone: 803-470-4076
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: AMANDA GILCHRIST
Title or Position: FOUNDER/CEO
Credential:
Phone: 803-470-4076