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General NPI Number Information
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NPI Number | 1336757517
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Entity Type | Organization
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Legal Business Name | WELLSPRING OF HOPE COUNSELING LLC
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Dates
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Enumeration Date | 07/14/2020
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Last Update Date | 10/26/2020
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Provider Practice Location Address
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Address Line | 110 HOSPITAL DR STE B
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City | SIMPSONVILLE
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State | SC
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Zip | 29681-3226
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Country | US
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Telephone | 864-688-2618
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Fax |
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Provider Business Mailing Address
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Address Line | 110 HOSPITAL DR STE B
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City | SIMPSONVILLE
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State | SC
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Zip | 29681-3226
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Country | US
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Telephone | 864-402-4044
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LOREN WATTS
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Credential | MS, LPC
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Telephone | 864-402-4044
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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