Healthcare Provider Details

I. General information

NPI: 1629564323
Provider Name (Legal Business Name): DJ HEALTHCARE GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2018
Last Update Date: 07/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

639 SULLIVAN STREET
LAURENS SC
29360
US

IV. Provider business mailing address

639 SULLIVAN STREET
LAURENS SC
29360
US

V. Phone/Fax

Practice location:
  • Phone: 864-300-1657
  • Fax:
Mailing address:
  • Phone: 864-300-1657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code374K00000X
TaxonomyReligious Nonmedical Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. DANA LEE
Title or Position: DIRECTOR
Credential:
Phone: 864-300-1657