Provider Demographics
NPI:1295829026
Name:LIFECARE PSYCHOLOGY GROUP, LLC
Entity Type:Organization
Organization Name:LIFECARE PSYCHOLOGY GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AVIE
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:RAINWATER
Authorized Official - Suffix:III
Authorized Official - Credentials:PHD
Authorized Official - Phone:843-667-4949
Mailing Address - Street 1:800 E CHEVES ST
Mailing Address - Street 2:SUITE 390
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29506-2650
Mailing Address - Country:US
Mailing Address - Phone:843-667-4949
Mailing Address - Fax:843-667-3349
Practice Address - Street 1:800 E CHEVES ST
Practice Address - Street 2:SUITE 390
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2650
Practice Address - Country:US
Practice Address - Phone:843-667-4949
Practice Address - Fax:843-667-3349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDC9436OtherMETRAHEALTH GROUP NUMBER
SCDC9436OtherMETRAHEALTH GROUP NUMBER