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General NPI Number Information
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NPI Number | 1407038847
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Entity Type | Organization
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Legal Business Name | GROWTHQUEST ENTERPRISES LLC
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Dates
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Enumeration Date | 11/27/2007
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Last Update Date | 11/27/2007
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Provider Practice Location Address
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Address Line | 119 N GOOSE CREEK BLVD SUITE B
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City | GOOSE CREEK
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State | SC
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Zip | 29445-2960
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Country | US
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Telephone | 843-408-4732
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Fax | 866-708-1623
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Provider Business Mailing Address
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Address Line | 119 N GOOSE CREEK BLVD SUITE B
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City | GOOSE CREEK
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State | SC
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Zip | 29445-2960
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Country | US
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Telephone | 843-408-4732
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Fax | 866-708-1623
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | SANDY M DAVIDSON
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Credential | LISW-CP
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Telephone | 843-408-4732
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 2399
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License Number State | SC
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