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General NPI Number Information
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NPI Number | 1174911028
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Entity Type | Organization
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Legal Business Name | S.C. RICHARDSON FOR BARIATRIC EVALUATIONS LLC
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Dates
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Enumeration Date | 12/30/2014
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Last Update Date | 12/30/2014
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Provider Practice Location Address
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Address Line | 3 JERVEY AVE
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City | GREENVILLE
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State | SC
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Zip | 29607-2308
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Country | US
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Telephone | 864-314-4537
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Fax |
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Provider Business Mailing Address
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Address Line | 3 JERVEY AVE
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City | GREENVILLE
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State | SC
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Zip | 29607-2308
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Country | US
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Telephone | 864-314-4537
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | SABRINA RICHARDSON
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Credential | LMFT
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Telephone | 864-314-4537
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 4574
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License Number State | SC
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