1487997730 NPI number — GIOVANNA BURGESS GEATHERS, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487997730 NPI number — GIOVANNA BURGESS GEATHERS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GIOVANNA BURGESS GEATHERS, LLC
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:
TOUCHSTONE COUNSELING
Provider Other Organization Name Type Code:
3
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:
1487997730
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/22/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
220 CLEAR LAKE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SIMPSONVILLE
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29680-6208
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-275-4022
Provider Business Mailing Address Fax Number:
888-817-0606

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24 VARDRY ST
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
GREENVILLE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29601-3540
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-451-2258
Provider Business Practice Location Address Fax Number:
888-817-0606
Provider Enumeration Date:
04/04/2013

Additional Information

Authorized Official

Authorized Official Last Name:
GEATHERS
Authorized Official First Name:
GIOVANNA
Authorized Official Middle Name:
BURGESS
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
864-275-4022

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  5375 , 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)

  • Identifier: 1790008068 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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