Healthcare Provider Details

I. General information

NPI: 1801674098
Provider Name (Legal Business Name): GREENVILLE LEARNING COLLECTIVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2023
Last Update Date: 09/19/2023
Certification Date: 09/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 MEMORIAL DR STE F
GREER SC
29650-1517
US

IV. Provider business mailing address

9 ELF LN
GREENVILLE SC
29617-1331
US

V. Phone/Fax

Practice location:
  • Phone: 864-451-2563
  • Fax:
Mailing address:
  • Phone: 713-702-8103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JACIE CURRY
Title or Position: OWNER/PARTNER
Credential: CCC-SLP
Phone: 864-451-2563