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General NPI Number Information
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NPI Number | 1659219053
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Entity Type | Organization
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Legal Business Name | MOSAIC MILESTONES CHILD AND FAMILY THERAPY LLC
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Dates
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Enumeration Date | 03/24/2026
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Last Update Date | 03/24/2026
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Provider Practice Location Address
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Address Line | 414 BRANCH CREEK TRL
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City | SUMMERVILLE
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State | SC
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Zip | 29483-5265
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Country | US
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Telephone | 704-914-6586
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Fax |
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Provider Business Mailing Address
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Address Line | 414 BRANCH CREEK TRL
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City | SUMMERVILLE
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State | SC
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Zip | 29483-5265
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Country | US
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Telephone | 704-914-6586
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TABITHA RUE STRONG
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Credential | PLC
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Telephone | 704-914-6586
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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