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General NPI Number Information
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NPI Number | 1902450737
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Entity Type | Organization
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Legal Business Name | THE JOURNEY BEHAVIORAL AND WELLNESS CLINIC, LLC
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Dates
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Enumeration Date | 07/30/2019
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Last Update Date | 10/15/2020
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Provider Practice Location Address
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Address Line | 1456 EBENEZER RD
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City | ROCK HILL
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State | SC
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Zip | 29732-2339
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Country | US
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Telephone | 803-693-6100
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Fax | 803-746-0923
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Provider Business Mailing Address
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Address Line | 5825 CASTLECOVE RD
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City | CHARLOTTE
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State | NC
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Zip | 28273-0500
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Country | US
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Telephone | 843-687-6768
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JENNIFER TURBEVILLE STUTTS
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Credential | FNP-BC, APRN
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Telephone | 843-687-6768
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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