Healthcare Provider Details

I. General information

NPI: 1285280396
Provider Name (Legal Business Name): ACHIEVE BEHAVIORAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2019
Last Update Date: 08/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 POINTE CIR STE A
GREENVILLE SC
29615-3505
US

IV. Provider business mailing address

81 POINTE CIR STE A
GREENVILLE SC
29615-3505
US

V. Phone/Fax

Practice location:
  • Phone: 803-622-5088
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: PATRICK HOGAN
Title or Position: MEMBER
Credential:
Phone: 803-622-5088