Healthcare Provider Details

I. General information

NPI: 1972928877
Provider Name (Legal Business Name): THERAPY CONNECTION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2014
Last Update Date: 02/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 TWO GAIT LN
SIMPSONVILLE SC
29680-6769
US

IV. Provider business mailing address

604 TWO GAIT LN
SIMPSONVILLE SC
29680-6769
US

V. Phone/Fax

Practice location:
  • Phone: 864-483-0354
  • Fax: 864-757-9209
Mailing address:
  • Phone: 864-483-0354
  • Fax: 864-757-9209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: TERRIE MCGILL
Title or Position: DIRECTOR
Credential:
Phone: 864-483-0354