Healthcare Provider Details

I. General information

NPI: 1497626469
Provider Name (Legal Business Name): SUBCONSCIOUS THERAPY SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2025
Last Update Date: 02/23/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2303 EXCALIBUR DR
INDIAN LAND SC
29707-9232
US

IV. Provider business mailing address

2303 EXCALIBUR DR
INDIAN LAND SC
29707-9232
US

V. Phone/Fax

Practice location:
  • Phone: 469-607-4305
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: NATHAN LEE ROBERSON
Title or Position: OWNER/PSYCHOTHERAPIST
Credential: LPC
Phone: 214-470-9039