Provider Demographics
NPI:1275900961
Name:GATEWAY CHILDREN'S
Entity Type:Organization
Organization Name:GATEWAY CHILDREN'S
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:KNOX-FRAZIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-406-6041
Mailing Address - Street 1:2153 E MAIN ST
Mailing Address - Street 2:STE C14-321
Mailing Address - City:DUNCAN
Mailing Address - State:SC
Mailing Address - Zip Code:29334-8724
Mailing Address - Country:US
Mailing Address - Phone:864-406-6041
Mailing Address - Fax:864-433-0119
Practice Address - Street 1:397 SERPENTINE DR
Practice Address - Street 2:STE B
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3067
Practice Address - Country:US
Practice Address - Phone:864-406-6041
Practice Address - Fax:864-406-6042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-28
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27451101YM0800X, 208000000X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty