Healthcare Provider Details

I. General information

NPI: 1962316091
Provider Name (Legal Business Name): WELCOME TO WELLNESS PSYCHIATRIC SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 BIRCH GARDEN DR
LONGS SC
29568-9507
US

IV. Provider business mailing address

909 BIRCH GARDEN DR
LONGS SC
29568-9507
US

V. Phone/Fax

Practice location:
  • Phone: 607-260-9005
  • Fax: 607-225-0040
Mailing address:
  • Phone: 607-260-9005
  • Fax: 607-225-0040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: STACEY MILLER
Title or Position: CEO, PSYCHIATRIC NURSE PRACTITIONER
Credential: PMHNP-BC
Phone: 607-260-9005