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General NPI Number Information
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NPI Number | 1184563652
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Entity Type | Organization
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Legal Business Name | BLACK RIVER LABS AND WELLNESS CENTER
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Dates
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Enumeration Date | 03/27/2026
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Last Update Date | 03/27/2026
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Provider Practice Location Address
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Address Line | 960 BERRY ST
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City | ORANGEBURG
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State | SC
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Zip | 29115-4317
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Country | US
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Telephone | 803-809-0099
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Fax |
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Provider Business Mailing Address
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Address Line | 960 BERRY ST
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City | ORANGEBURG
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State | SC
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Zip | 29115-4317
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Country | US
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Telephone | 803-809-0099
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. FELECIA SHAVON SCOTT
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Credential | CPT, MA, BA PSY
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Telephone | 803-809-0099
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246RM2200X
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Taxonomy Name | Medical Laboratory Technician
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License Number |
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License Number State |
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