MEDICARE: LET THE SUNSHINE IN LLC

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
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1962114827
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LET THE SUNSHINE IN LLC

Provider Business Mailing Address
First Line	:	406 PARKER IVEY DR
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29607-6513
Country	:	US
Telephone Number	:	864-395-6786
Fax Number	:	864-900-0452

Provider Business Practice Location Address
First Line	:	406 PARKER IVEY DR
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29607-6513
Country	:	US
Telephone Number	:	864-395-6786
Fax Number	:	864-900-0452

Authorized Official
Title or Position	:	OWNER
Name	:	CANDACE SMITH JACKSON
Credential	:	LPC
Telephone Number	:	864-395-6786

Provider Enumeration Date	:	12/21/2022
Last Update Date	:	12/21/2022

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Directions to “LET THE SUNSHINE IN LLC ” Practice Location

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