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General NPI Number Information
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NPI Number | 1215309869
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Entity Type | Organization
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Legal Business Name | ATLANTIS PSYCHOTHERAPY AND PSYCHOEDUCATION CENTER
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Dates
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Enumeration Date | 10/22/2015
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Last Update Date | 10/22/2015
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Provider Practice Location Address
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Address Line | 269 S CHURCH ST SUITE 205
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City | SPARTANBURG
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State | SC
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Zip | 29306-3496
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Country | US
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Telephone | 980-307-0720
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Fax |
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Provider Business Mailing Address
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Address Line | 757 CHARLESTON PL
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City | DUNCAN
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State | SC
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Zip | 29334-8728
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Country | US
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Telephone | 980-307-0720
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | MR. RYAN BENSON FEEMSTER
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Credential | M.ED, NCC, LPC-I
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Telephone | 980-307-0720
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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 | 6206
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License Number State | SC
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