Provider Demographics
NPI:1578133781
Name:THERAPY RESOURCE GROUP
Entity Type:Organization
Organization Name:THERAPY RESOURCE GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/CLINICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:FOSTER
Authorized Official - Last Name:GASKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LPC, LCMHCA
Authorized Official - Phone:704-931-1010
Mailing Address - Street 1:117 SPRATT ST STE B
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29715-4111
Mailing Address - Country:US
Mailing Address - Phone:704-931-1010
Mailing Address - Fax:
Practice Address - Street 1:117 SPRATT ST STE B
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29715-4111
Practice Address - Country:US
Practice Address - Phone:704-931-1010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-29
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental IllnessGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1952994683OtherBCBS
SC1952994683OtherUNITED
SC1952994683OtherCAHQ
SC1952994683OtherTRICARE