Healthcare Provider Details

I. General information

NPI: 1730419268
Provider Name (Legal Business Name): TUWAN M USSERY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2010
Last Update Date: 01/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 E MAIN ST SUITE 300
ROCK HILL SC
29730-4571
US

IV. Provider business mailing address

250 PIEDMONT BLVD
ROCK HILL SC
29732-1835
US

V. Phone/Fax

Practice location:
  • Phone: 803-328-9600
  • Fax: 803-329-7141
Mailing address:
  • Phone: 803-328-9600
  • Fax: 803-329-7141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: