1699088070 NPI number — GREENVILLE COUNTY DISABILITIES AND SPECIAL NEEDS BOARD

Table of content: MS. SARAH ELIZABETH TENBROEK LICSW (NPI 1801140538)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699088070 NPI number — GREENVILLE COUNTY DISABILITIES AND SPECIAL NEEDS BOARD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREENVILLE COUNTY DISABILITIES AND SPECIAL NEEDS BOARD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699088070
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/28/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 17467
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENVILLE
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29606-8467
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-288-1907
Provider Business Mailing Address Fax Number:
864-297-4990

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1700 RIDGE ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENVILLE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29607-4730
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-288-1907
Provider Business Practice Location Address Fax Number:
864-297-4990
Provider Enumeration Date:
07/14/2010

Additional Information

Authorized Official

Authorized Official Last Name:
COCCIOLONE
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
864-288-1907

Provider Taxonomy Codes

  • Taxonomy code: 320900000X , with the licence number:  42G128 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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