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General NPI Number Information
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NPI Number | 1720853211
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Entity Type | Organization
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Legal Business Name | BLEND INTEGRATIVE THERAPY & WELLNESS
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Dates
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Enumeration Date | 11/15/2023
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Last Update Date | 11/15/2023
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Provider Practice Location Address
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Address Line | 162 TWO POND LOOP
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City | LADSON
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State | SC
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Zip | 29456-6916
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Country | US
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Telephone | 843-284-3997
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Fax |
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Provider Business Mailing Address
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Address Line | 1318 N MAIN ST # M19210
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City | SUMMERVILLE
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State | SC
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Zip | 29483-7308
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Country | US
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Telephone | 843-284-3997
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Fax |
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | CAROL L CONWAY
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Credential | LISW-CP
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Telephone | 843-991-1543
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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 |
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License Number State |
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