1841412491 NPI number — SWEETGRASS PSYCHOLOGICAL SERVICES LLC

Table of content: MR. ANTHONY DAVIS SINGLETON SR. SA (NPI 1396088779)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841412491 NPI number — SWEETGRASS PSYCHOLOGICAL SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SWEETGRASS PSYCHOLOGICAL SERVICES 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:
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:
1841412491
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:
222 WEST COLEMAN BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MT. PLEASANT
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29464
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
222 WEST COLEMAN BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MT. PLEASANT
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29464
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-532-8442
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RHODES
Authorized Official First Name:
AMY
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
OWNER MANAGER
Authorized Official Telephone Number:
843-532-8442

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  1032 , 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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