=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245057249
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE MEDICAL TRAINING INSTITUTE INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/23/2024
-----------------------------------------------------
Last Update Date | 09/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1801 W EVANS ST STE D100
-----------------------------------------------------
City | FLORENCE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29501-3376
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-506-6817
-----------------------------------------------------
Fax | 888-781-9149
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1801 W EVANS ST STE D100
-----------------------------------------------------
City | FLORENCE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29501-3376
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-506-6817
-----------------------------------------------------
Fax | 888-781-9149
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROGRAM DIRECTOR
-----------------------------------------------------
Name | MS. KIANA CHEVONNE BROWN
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 843-506-6817
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------