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General NPI Number Information
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NPI Number | 1770560526
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Entity Type | Organization
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Legal Business Name | TEEN HEALTH CENTER
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Dates
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Enumeration Date | 12/22/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 725 CHERRY RD SUITE 104
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City | ROCK HILL
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State | SC
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Zip | 29732-3150
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Country | US
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Telephone | 803-366-9119
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Fax | 803-366-9389
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Provider Business Mailing Address
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Address Line | 725 CHERRY RD SUITE 104
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City | ROCK HILL
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State | SC
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Zip | 29732-3150
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Country | US
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Telephone | 803-366-9119
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Fax | 803-366-9389
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. JANICE E RICHARDS
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Credential |
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Telephone | 803-366-9119
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 77686
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License Number State | SC
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