Healthcare Provider Details

I. General information

NPI: 1518688993
Provider Name (Legal Business Name): TOXICOLOGY X DIAGNOSTICS SCREENINGS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2022
Last Update Date: 09/06/2022
Certification Date: 09/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 MONROE ST
NEWBERRY SC
29108-3186
US

IV. Provider business mailing address

515 MONROE ST
NEWBERRY SC
29108-3186
US

V. Phone/Fax

Practice location:
  • Phone: 803-609-6678
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License Number
License Number State

VIII. Authorized Official

Name: DARNASHA HOUSEAL
Title or Position: OWNER
Credential: LPN
Phone: 803-609-6678