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General NPI Number Information
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NPI Number | 1770063315
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Entity Type | Organization
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Legal Business Name | SPRINGS OF LIFE COUNSELING LLC
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Dates
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Enumeration Date | 08/14/2018
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Last Update Date | 08/14/2018
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Provider Practice Location Address
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Address Line | 1808 SECOND BAXTER XING STE 208
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City | FORT MILL
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State | SC
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Zip | 29708-6492
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Country | US
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Telephone | 803-626-6200
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Fax |
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Provider Business Mailing Address
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Address Line | 123 HAWKS CREEK PKWY
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City | FORT MILL
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State | SC
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Zip | 29708-0026
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Country | US
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Telephone | 803-626-6200
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TAMMY L JAMES
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Credential | LISW
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Telephone | 803-626-6200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 12751
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License Number State | SC
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