Healthcare Provider Details

I. General information

NPI: 1902450737
Provider Name (Legal Business Name): THE JOURNEY BEHAVIORAL AND WELLNESS CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2019
Last Update Date: 10/15/2020
Certification Date: 10/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1456 EBENEZER RD
ROCK HILL SC
29732-2339
US

IV. Provider business mailing address

5825 CASTLECOVE RD
CHARLOTTE NC
28273-0500
US

V. Phone/Fax

Practice location:
  • Phone: 803-693-6100
  • Fax: 803-746-0923
Mailing address:
  • Phone: 843-687-6768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER TURBEVILLE STUTTS
Title or Position: OWNER
Credential: FNP-BC, APRN
Phone: 843-687-6768