Provider Demographics
NPI:1790765980
Name:REGIONAL PSYCHIATRY
Entity Type:Organization
Organization Name:REGIONAL PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGEMENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARCHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:GARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:864-560-7551
Mailing Address - Street 1:100 E WOOD ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29303-3004
Mailing Address - Country:US
Mailing Address - Phone:864-560-7517
Mailing Address - Fax:864-560-7520
Practice Address - Street 1:100 E WOOD ST
Practice Address - Street 2:SUITE 200
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3004
Practice Address - Country:US
Practice Address - Phone:864-560-7517
Practice Address - Fax:864-560-7520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC21107OtherSC LICENSE
SC211078Medicaid
SCH37909Medicare UPIN