Healthcare Provider Details

I. General information

NPI: 1124586524
Provider Name (Legal Business Name): CAROLINA WELLNESS AND RECOVERY OF POWDERSVILLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2019
Last Update Date: 03/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 CLAIR DR STE C
PIEDMONT SC
29673-6401
US

IV. Provider business mailing address

52 PARKWAY COMMONS WAY
GREER SC
29650-5213
US

V. Phone/Fax

Practice location:
  • Phone: 864-655-4530
  • Fax: 864-416-4799
Mailing address:
  • Phone: 864-655-4350
  • Fax: 864-416-4799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER ELLEN HILL
Title or Position: PROGRAM DIRECTOR/CO-OWNER
Credential:
Phone: 864-887-6190