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General NPI Number Information
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NPI Number | 1114477320
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Entity Type | Organization
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Legal Business Name | THREE SPRINGS DIALECTICAL BEHAVIOR THERAPY OF THE UPSTATE, LLC
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Dates
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Enumeration Date | 10/12/2016
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Last Update Date | 10/12/2016
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Provider Practice Location Address
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Address Line | 14 MANLY ST
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City | GREENVILLE
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State | SC
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Zip | 29601-3023
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Country | US
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Telephone | 864-918-8091
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Fax | 864-474-2097
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Provider Business Mailing Address
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Address Line | 14 MANLY ST
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City | GREENVILLE
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State | SC
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Zip | 29601-3023
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Country | US
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Telephone | 864-918-8091
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Fax | 864-474-2097
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Authorized Official
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Title or Position | MEMBER
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Name | MARY CROLEY KNIGHT
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Credential | LPC
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Telephone | 864-918-8091
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | SC
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