Healthcare Provider Details

I. General information

NPI: 1063973394
Provider Name (Legal Business Name): LAURENS DSN BOARD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2019
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

364 EVERGREEN SKILLS RD
LAURENS SC
29360-7043
US

IV. Provider business mailing address

364 EVERGREEN SKILLS RD
LAURENS SC
29360-7043
US

V. Phone/Fax

Practice location:
  • Phone: 864-683-5626
  • Fax:
Mailing address:
  • Phone: 864-683-5626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: BETH HINSON WILSON
Title or Position: FINANCE DIRECTOR
Credential:
Phone: 864-683-5626