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General NPI Number Information
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NPI Number | 1568739266
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Entity Type | Organization
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Legal Business Name | ROCK BOTTOM RENEWAL, LLC
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Dates
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Enumeration Date | 11/23/2011
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Last Update Date | 11/23/2011
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Provider Practice Location Address
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Address Line | 425 N MAIN ST STE B
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City | SIMPSONVILLE
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State | SC
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Zip | 29681-2062
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Country | US
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Telephone | 864-735-5228
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 21
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City | SIMPSONVILLE
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State | SC
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Zip | 29681-0021
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Country | US
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Telephone | 864-735-5228
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Fax |
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Authorized Official
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Title or Position | FOUNDER: ROCK BOTTOM RENEWAL, LLC
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Name | MR. RYAN NEIL SCHMIDT
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Credential | LPC
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Telephone | 864-735-5228
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 5255
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 5255
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 5255
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License Number State | SC
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Taxonomy #4
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 5255
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License Number State | SC
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