1205885522 NPI number — FAMILY THERAPY & TRAUMA CENTER

Table of content: (NPI 1205885522)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205885522 NPI number — FAMILY THERAPY & TRAUMA CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY THERAPY & TRAUMA CENTER
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:
1205885522
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
311 BENNETT CENTER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREER
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29650-1259
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-968-9687
Provider Business Mailing Address Fax Number:
864-968-9449

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
311 BENNETT CENTER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREER
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29650-1259
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-968-9687
Provider Business Practice Location Address Fax Number:
864-968-9449
Provider Enumeration Date:
05/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HARRIS
Authorized Official First Name:
CHRYS
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
CLINICAL DIRECTOR
Authorized Official Telephone Number:
864-968-9687

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  LPC#1204 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 106H00000X , with the licence number: LMFT#1775 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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





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