Healthcare Provider Details

I. General information

NPI: 1730589706
Provider Name (Legal Business Name): DEVONTA CHILDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2014
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8441 OLD STATE ROAD
HOLLY HILL SC
29059
US

IV. Provider business mailing address

136 DECENDANT DR
HOLLY HILL SC
29059-9023
US

V. Phone/Fax

Practice location:
  • Phone: 803-997-0840
  • Fax: 803-265-3365
Mailing address:
  • Phone: 803-997-0840
  • Fax: 803-265-3365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: