Healthcare Provider Details

I. General information

NPI: 1194540336
Provider Name (Legal Business Name): RE-BOUND-IT INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2024
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 E BLACK ST STE 106
ROCK HILL SC
29730-5341
US

IV. Provider business mailing address

417 E BLACK ST STE 106
ROCK HILL SC
29730-5341
US

V. Phone/Fax

Practice location:
  • Phone: 803-327-8888
  • Fax:
Mailing address:
  • Phone: 803-327-8888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DONETTA GRAHAM
Title or Position: EXECUTIVE DIRECTIVE
Credential:
Phone: 803-327-8888