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General NPI Number Information
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NPI Number | 1023704178
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Entity Type | Organization
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Legal Business Name | E-CITY'S UNBROKEN
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Dates
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Enumeration Date | 04/12/2023
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Last Update Date | 04/12/2023
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Provider Practice Location Address
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Address Line | 2315 N MAIN ST STE 221B
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City | ANDERSON
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State | SC
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Zip | 29621-3888
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Country | US
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Telephone | 864-238-6394
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Fax |
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Provider Business Mailing Address
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Address Line | 2315 N MAIN ST STE 221B
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City | ANDERSON
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State | SC
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Zip | 29621-3888
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Country | US
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Telephone | 864-238-6394
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | CASSEY HANKS
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Credential |
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Telephone | 864-238-6394
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 225C00000X
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Taxonomy Name | Rehabilitation Counselor
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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