=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831991587
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOBRIETY OF HOPE MENTAL HEALTH AND ADDICTION CENTER, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/25/2025
-----------------------------------------------------
Last Update Date | 06/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 110 PARK PL
-----------------------------------------------------
City | LAURENS
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29360-3326
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-872-1223
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 110 PARK PL
-----------------------------------------------------
City | LAURENS
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29360-3326
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-872-1223
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROVIDER
-----------------------------------------------------
Name | SHELIA HARRIS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 864-872-1223
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------