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General NPI Number Information
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NPI Number | 1962001321
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Entity Type | Organization
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Legal Business Name | FUTURE GEMS GREENVILLE ENTREPRENEUR MENTORSHIP
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Dates
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Enumeration Date | 10/17/2020
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Last Update Date | 10/17/2020
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Provider Practice Location Address
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Address Line | 133 ARNOLD MILL RD
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City | SIMPSONVILLE
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State | SC
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Zip | 29680-7293
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Country | US
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Telephone | 267-671-2311
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Fax | 864-412-7989
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Provider Business Mailing Address
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Address Line | 133 ARNOLD MILL RD
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City | SIMPSONVILLE
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State | SC
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Zip | 29680-7293
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Country | US
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Telephone | 267-671-2311
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Fax | 864-412-7989
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Authorized Official
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Title or Position | PRESIDENT
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Name | TAMIKA T STEVENSON
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Credential |
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Telephone | 267-671-2311
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM1100X
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Taxonomy Name | Military/U.S. Coast Guard Outpatient Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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