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Contact Information

TABLE ROCK INTEGRATED HEALTH AND WELLNESS PRACTICE, LLC.
5 CENTER ST
TRAVELERS REST, SC29690-1826
 Phone: 864-908-6372
 Fax: 864-898-3703
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Psychiatry

2084P0800X 26 Physician/Psychiatry
 

Clinical

1041C0700X 80 Licensed Clinical Social Worker
 

Geriatric Psychiatry

2084P0805X 86 Physician/Neuropsychiatry
 

Professional

101YP2500X
Indicates primary specialty

NPI Profile & details for TABLE ROCK INTEGRATED HEALTH AND WELLNESS PRACTICE LLC · (Female)

NPI # 1104145184
Status Active
Credentials
Entity Individual
Enumeration date 05/31/2010
Last updated 03/16/2020 - About 6 years ago
Sole proprietor 1 Not specified
Identifiers
  • SC License # 1223
  • SC License # 30719
  • SC License # 5825
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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