Healthcare Provider Details

I. General information

NPI: 1528153517
Provider Name (Legal Business Name): COLLABORATION IN HEALING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 01/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHICK SPRINGS RD SUITE NUMBER 216 B
GREENVILLE SC
29609-4946
US

IV. Provider business mailing address

1 CHICK SPRINGS RD SUITE NUMBER 216 B
GREENVILLE SC
29609-4946
US

V. Phone/Fax

Practice location:
  • Phone: 864-630-4827
  • Fax:
Mailing address:
  • Phone: 864-630-4827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMAS 2076
License Number StateSC

VIII. Authorized Official

Name: MS. KATIE TAYLOR
Title or Position: OWNER
Credential: MPH, LMBT, HTP
Phone: 864-630-4827