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General NPI Number Information
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NPI Number | 1649071960
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Entity Type | Organization
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Legal Business Name | PSYCHIATRYSPACE, PC
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Dates
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Enumeration Date | 03/22/2025
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Last Update Date | 03/22/2025
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Provider Practice Location Address
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Address Line | 410 UNIVERSITY PARKWAY SUITE 2300
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City | AIKEN
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State | SC
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Zip | 29801-6807
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Country | US
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Telephone | 540-250-6776
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Fax | 540-382-1517
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Provider Business Mailing Address
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Address Line | 19 PAVILION LAKE RD
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City | NORTH AUGUSTA
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State | SC
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Zip | 29860-7520
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Country | US
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Telephone | 540-204-8111
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | STELLA BASSEY
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Credential | MD
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Telephone | 540-250-6776
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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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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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