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General NPI Number Information
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NPI Number | 1639849557
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Entity Type | Organization
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Legal Business Name | SOUTH CAROLINA CENTER OF HEALING
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Dates
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Enumeration Date | 09/14/2021
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Last Update Date | 09/14/2021
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Provider Practice Location Address
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Address Line | 121A GADSDEN ST
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City | CHESTER
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State | SC
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Zip | 29706-2009
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Country | US
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Telephone | 631-949-0090
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Fax |
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Provider Business Mailing Address
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Address Line | 2837 SAND COVE CT
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City | DENVER
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State | NC
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Zip | 28037-4700
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Country | US
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Telephone | 631-949-0090
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ENJOLI RAE ORTIZ
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Credential |
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Telephone | 631-949-0090
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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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