Healthcare Provider Details

I. General information

NPI: 1922613090
Provider Name (Legal Business Name): HEALING MENTORS FOR CHRIST INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2020
Last Update Date: 09/15/2020
Certification Date: 09/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 HAYMOUNT RD
LATTA SC
29565-5306
US

IV. Provider business mailing address

605 HAYMOUNT RD
LATTA SC
29565-5306
US

V. Phone/Fax

Practice location:
  • Phone: 843-758-5280
  • Fax:
Mailing address:
  • Phone: 843-758-5280
  • Fax:

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 Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: MISS ALICIA MORRISON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 843-758-5280