Healthcare Provider Details

I. General information

NPI: 1396924056
Provider Name (Legal Business Name): JOSHUA GERALD MENK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2007
Last Update Date: 05/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

724 RUTHERFORD RD
GREENVILLE SC
29609-3809
US

IV. Provider business mailing address

4 PARKWAY COMMONS WAY
GREER SC
29650-5213
US

V. Phone/Fax

Practice location:
  • Phone: 864-704-0233
  • Fax:
Mailing address:
  • Phone: 864-704-0233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number101544638
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5481
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: