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General NPI Number Information
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NPI Number | 1760153100
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Entity Type | Organization
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Legal Business Name | UPSTATE INTEGRATIVE FAMILY THERAPY, LLC
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Dates
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Enumeration Date | 09/24/2021
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Last Update Date | 09/24/2021
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Provider Practice Location Address
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Address Line | 4328 WADE HAMPTON BLVD SUITE C
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City | TAYLORS
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State | SC
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Zip | 29687
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Country | US
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Telephone | 864-735-7174
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Fax |
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Provider Business Mailing Address
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Address Line | 4328 WADE HAMPTON BLVD SUITE C
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City | TAYLORS
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State | SC
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Zip | 29687
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Country | US
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Telephone | 864-735-7174
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LORIE PORTER
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Credential | MMFT
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Telephone | 864-735-7174
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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