Provider Demographics
NPI:1316023286
Name:UPSTATE THERAPY, LLC
Entity Type:Organization
Organization Name:UPSTATE THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:QUARTERMAINE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:864-608-4514
Mailing Address - Street 1:419 THE PARKWAY
Mailing Address - Street 2:PMB 109
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650
Mailing Address - Country:US
Mailing Address - Phone:864-608-4514
Mailing Address - Fax:864-627-9770
Practice Address - Street 1:125 THE PARKWAY
Practice Address - Street 2:SUITE 104
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615
Practice Address - Country:US
Practice Address - Phone:864-608-4514
Practice Address - Fax:864-627-9770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC3685101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty