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General NPI Number Information
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NPI Number | 1467038828
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Entity Type | Organization
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Legal Business Name | FAITH & FLY PSYCHIATRIC PRACTICE, LLC
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Dates
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Enumeration Date | 03/24/2021
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Last Update Date | 03/24/2021
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Provider Practice Location Address
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Address Line | 2424 INDIA HOOK RD
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City | ROCK HILL
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State | SC
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Zip | 29732-2784
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Country | US
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Telephone | 803-801-0878
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Fax |
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Provider Business Mailing Address
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Address Line | 3326 JACKSON CREEK RD
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City | WINNSBORO
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State | SC
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Zip | 29180-6600
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PMHNP-BC
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Name | MARY GOLDIN
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Credential |
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Telephone | 803-801-0878
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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