Healthcare Provider Details

I. General information

NPI: 1063806495
Provider Name (Legal Business Name): YOLANDA URENA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2015
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 PELHAM RD STE A
GREENVILLE SC
29615-2142
US

IV. Provider business mailing address

12 PELHAM RD STE A
GREENVILLE SC
29615-2142
US

V. Phone/Fax

Practice location:
  • Phone: 864-735-7675
  • Fax:
Mailing address:
  • Phone: 864-735-7675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7579
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: