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General NPI Number Information
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NPI Number | 1710662341
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Entity Type | Organization
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Legal Business Name | SANDALWOOD MENTAL HEALTH, PLLC
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Dates
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Enumeration Date | 06/20/2023
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Last Update Date | 02/19/2025
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Provider Practice Location Address
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Address Line | 244 LATITUDE LN STE 104
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City | LAKE WYLIE
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State | SC
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Zip | 29710-8125
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Country | US
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Telephone | 803-809-3184
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Fax | 803-615-4662
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Provider Business Mailing Address
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Address Line | PO BOX 1081
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City | CLOVER
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State | SC
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Zip | 29710-4081
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Country | US
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Telephone | 803-809-3184
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Fax | 803-615-4662
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Authorized Official
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Title or Position | CEO
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Name | PETER A. BERTELLI
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Credential | APRN
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Telephone | 508-538-3165
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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