Healthcare Provider Details

I. General information

NPI: 1700673530
Provider Name (Legal Business Name): COUNSELING FOR TRAUMA RECOVERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2025
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7101 SHORT LEAF PINE CIR
GREENVILLE SC
29609-1360
US

IV. Provider business mailing address

5052 OLD BUNCOMBE RD STE A1103
GREENVILLE SC
29617-8259
US

V. Phone/Fax

Practice location:
  • Phone: 864-531-2601
  • Fax:
Mailing address:
  • Phone: 864-531-2601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: MEGHAN BRAIN CONNECTION BOWDEN
Title or Position: OWNER
Credential: LISW-CP
Phone: 864-531-2601