Provider Demographics
NPI:1710208863
Name:RECREATING POSITIVE LIVING LLC
Entity Type:Organization
Organization Name:RECREATING POSITIVE LIVING LLC
Other - Org Name:RECREATING POSITIVE LIVING COUNSELING AND CONSULTING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:TANNER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, NCC
Authorized Official - Phone:864-415-8640
Mailing Address - Street 1:344 ROBIN HELTON DR
Mailing Address - Street 2:
Mailing Address - City:BOILING SPRINGS
Mailing Address - State:SC
Mailing Address - Zip Code:29316-5380
Mailing Address - Country:US
Mailing Address - Phone:864-415-8640
Mailing Address - Fax:
Practice Address - Street 1:2375 E MAIN ST
Practice Address - Street 2:SUITE A-150 OFFICE 102
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29307-1434
Practice Address - Country:US
Practice Address - Phone:864-415-8640
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-11
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6631251S00000X
SC4864251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health