Healthcare Provider Details

I. General information

NPI: 1912546532
Provider Name (Legal Business Name): WELL GREENVILLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2019
Last Update Date: 12/30/2019
Certification Date: 12/30/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 N IRVINE ST
GREENVILLE SC
29601-4900
US

IV. Provider business mailing address

418 PINCKNEY ST
GREENVILLE SC
29601-1120
US

V. Phone/Fax

Practice location:
  • Phone: 864-900-4007
  • Fax:
Mailing address:
  • Phone: 864-900-4007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: BAILEY NEVELS
Title or Position: SOLE MEMBER
Credential: PH.D.
Phone: 864-900-4007