Provider Demographics
NPI:1346765534
Name:UNIVERSAL PROGRAM OF RECOVERY LLC
Entity Type:Organization
Organization Name:UNIVERSAL PROGRAM OF RECOVERY LLC
Other - Org Name:ANDREA R THORPE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER, THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:THORPE
Authorized Official - Suffix:
Authorized Official - Credentials:LISW-CP,MAC, ICAADC,
Authorized Official - Phone:623-628-0714
Mailing Address - Street 1:640 OLD BACK RIVER RD
Mailing Address - Street 2:
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-7825
Mailing Address - Country:US
Mailing Address - Phone:623-628-0714
Mailing Address - Fax:843-297-4456
Practice Address - Street 1:640 OLD BACK RIVER RD
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-7825
Practice Address - Country:US
Practice Address - Phone:623-628-0714
Practice Address - Fax:843-297-4456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-08
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC508240101YA0400X
GAC0160101YA0400X
GA2085R101YA0400X
SC120641041C0700X
GACSW0050411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSW1385Medicaid