Healthcare Provider Details

I. General information

NPI: 1093505505
Provider Name (Legal Business Name): TISHA HURTEAU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2025
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 CENTRAL PARK LN
SENECA SC
29678-1156
US

IV. Provider business mailing address

203 CENTRAL PARK LN
SENECA SC
29678-1156
US

V. Phone/Fax

Practice location:
  • Phone: 706-961-4156
  • Fax: 864-973-8965
Mailing address:
  • Phone: 706-961-4156
  • Fax: 864-973-8965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14779
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: