Healthcare Provider Details

I. General information

NPI: 1639697642
Provider Name (Legal Business Name): STIGMA INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 E BUTLER RD APT 228
GREENVILLE SC
29607-5870
US

IV. Provider business mailing address

815 EAST BUTLER RD UNIT 228
GREENVILLE SC
29607-5870
US

V. Phone/Fax

Practice location:
  • Phone: 864-660-9474
  • Fax: 866-441-8077
Mailing address:
  • Phone: 864-660-9474
  • Fax: 866-441-8077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: SHAKISHA DAVIS
Title or Position: CEO
Credential: M.ED.
Phone: 864-660-9474