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General NPI Number Information
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NPI Number | 1871334227
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Entity Type | Organization
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Legal Business Name | PROVIDENT HEALTH CARE LLC
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Dates
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Enumeration Date | 05/31/2024
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Last Update Date | 09/23/2025
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Provider Practice Location Address
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Address Line | 314 MAIN ST UPPR LEVEL
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City | GREENWOOD
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State | SC
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Zip | 29646-2758
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Country | US
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Telephone | 252-955-2354
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Fax | 336-232-1516
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Provider Business Mailing Address
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Address Line | PO BOX 1705
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City | JAMESTOWN
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State | NC
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Zip | 27282-1705
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Country | US
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Telephone | 252-955-2354
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Fax | 336-232-1516
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. ROBERTA DENISE BRINKLEY
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Credential | LCMHC
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Telephone | 252-955-2354
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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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