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General NPI Number Information
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NPI Number | 1639569049
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Entity Type | Organization
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Legal Business Name | THREE TREES CENTER FOR CHANGE
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Dates
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Enumeration Date | 01/23/2015
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Last Update Date | 01/23/2015
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Provider Practice Location Address
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Address Line | 546 S CHERRY RD SUITE L
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City | ROCK HILL
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State | SC
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Zip | 29732-3487
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Country | US
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Telephone | 803-207-0558
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4965
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City | ROCK HILL
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State | SC
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Zip | 29732-6965
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Country | US
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Telephone | 803-207-0558
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Fax | 877-752-1347
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Authorized Official
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Title or Position | OWNER
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Name | BENJAMIN MOTLEY
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Credential | MA,CCFC,CCSOTS
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Telephone | 803-207-0558
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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