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NPI Code Detail

MEDICARE: MARIA ROUNDTREE

MEDICARE: MARIA ROUNDTREE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1730691791
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIA ROUNDTREE
Provider Business Mailing Address
First Line : 55 BEATTIE PL STE 810
Second Line :
City : GREENVILLE
State : SC
Zip : 29601-2191
Country : US
Telephone Number : 864-527-3145
Fax Number : 864-990-0653
Provider Business Practice Location Address
First Line : 1451 RETAIL ROW
Second Line :
City : HARTSVILLE
State : SC
Zip : 29550-4258
Country : US
Telephone Number : 843-383-4848
Fax Number : 843-383-4828
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/31/2017
Last Update Date : 10/31/2017

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