Healthcare Provider Details

I. General information

NPI: 1356977417
Provider Name (Legal Business Name): VIRTUAL TRAINING AND DEVELOPMENT SOLUTIONS, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2020
Last Update Date: 03/19/2020
Certification Date: 03/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

716 E FAIRFIELD RD STE 111
GREENVILLE SC
29605-3688
US

IV. Provider business mailing address

PO BOX 8135
GREENVILLE SC
29604-8135
US

V. Phone/Fax

Practice location:
  • Phone: 706-983-9096
  • Fax:
Mailing address:
  • Phone: 706-983-9096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. ALICIA BROWN
Title or Position: CEO/EDUCATOR
Credential: DHSC MSED MSTD BS
Phone: 706-983-9096