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General NPI Number Information
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NPI Number | 1710208863
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Entity Type | Organization
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Legal Business Name | RECREATING POSITIVE LIVING LLC
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Dates
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Enumeration Date | 06/11/2010
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Last Update Date | 11/05/2010
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Provider Practice Location Address
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Address Line | 2375 E MAIN ST SUITE A-150 OFFICE 102
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City | SPARTANBURG
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State | SC
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Zip | 29307-1434
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Country | US
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Telephone | 864-415-8640
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Fax |
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Provider Business Mailing Address
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Address Line | 344 ROBIN HELTON DR
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City | BOILING SPRINGS
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State | SC
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Zip | 29316-5380
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Country | US
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Telephone | 864-415-8640
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | MS. ANGELA LOUISE TANNER
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Credential | MA, LPC, NCC
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Telephone | 864-415-8640
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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 | 4864
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 6631
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License Number State | NC
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