NPI 1003167990 · live from the CMS NPI Registry
All About Change
Marriage & Family Therapist in Greenville, SC. National Provider Identifier 1003167990, active.
NPI record
| NPI | 1003167990 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Marriage & Family Therapist 106H00000X |
| Practice location | 850 Wade Hampton Blvd, Suite C, Greenville, SC 29609 |
| Practice phone | 864-704-0931 |
| Enumerated | October 2, 2012 |
| Last updated | October 2, 2012 |
| Authorized official | Kelly Roseberry, Executive Director |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Counselor, Professional | 101YP2500X | 5080 (SC) |
| Marriage & Family Therapist primary | 106H00000X | 4497 (SC) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.