Healthcare Provider Details

I. General information

NPI: 1912832874
Provider Name (Legal Business Name): THEORYM MENTAL HEALTH & WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 SWEETBRIAR RD STE A6
GREENVILLE SC
29615-1462
US

IV. Provider business mailing address

25 SWEETBRIAR RD STE A6
GREENVILLE SC
29615-1462
US

V. Phone/Fax

Practice location:
  • Phone: 864-790-4963
  • Fax: 877-744-5147
Mailing address:
  • Phone: 864-790-4963
  • Fax: 877-744-5147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. JENNIE LEE GAMBLE
Title or Position: LPC/OWNER
Credential: M.ED., LPC
Phone: 864-790-4963