Healthcare Provider Details

I. General information

NPI: 1780552687
Provider Name (Legal Business Name): BLUE ROCK THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2025
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 PLAZA DR UNIT 131
LUGOFF SC
29078-2105
US

IV. Provider business mailing address

40 PLAZA DR UNIT 131
LUGOFF SC
29078-2105
US

V. Phone/Fax

Practice location:
  • Phone: 803-271-0714
  • Fax:
Mailing address:
  • Phone: 803-271-0714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: TONYA BARKLEY
Title or Position: OWNER/THERAPIST
Credential: LISW-CP, ADC
Phone: 803-528-0815