Provider Demographics
NPI:1174911028
Name:S.C. RICHARDSON FOR BARIATRIC EVALUATIONS LLC
Entity type:Organization
Organization Name:S.C. RICHARDSON FOR BARIATRIC EVALUATIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SABRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:864-314-4537
Mailing Address - Street 1:3 JERVEY AVE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-2308
Mailing Address - Country:US
Mailing Address - Phone:864-314-4537
Mailing Address - Fax:
Practice Address - Street 1:3 JERVEY AVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-2308
Practice Address - Country:US
Practice Address - Phone:864-314-4537
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-30
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4574106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty