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General NPI Number Information
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NPI Number | 1316569213
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Entity Type | Organization
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Legal Business Name | POSITIVE STARTS LLC
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Dates
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Enumeration Date | 05/13/2020
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Last Update Date | 05/13/2020
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Provider Practice Location Address
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Address Line | 102 COMMONS BLVD STE C
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City | PIEDMONT
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State | SC
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Zip | 29673-7766
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Country | US
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Telephone | 864-804-1560
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Fax |
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Provider Business Mailing Address
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Address Line | 1667 HIGHWAY 11 W
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City | CHESNEE
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State | SC
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Zip | 29323-9330
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Country | US
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Telephone | 864-804-1560
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Fax |
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | MS. ROXIE MEDLEY
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Credential | LPC
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Telephone | 864-804-1560
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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