Provider Demographics
NPI:1972265502
Name:UPSTATE ADHD CENTER, LLC
Entity Type:Organization
Organization Name:UPSTATE ADHD CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMAKE
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, PMHNP-BC, APRN
Authorized Official - Phone:864-714-5637
Mailing Address - Street 1:PO BOX 25472
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29616-0472
Mailing Address - Country:US
Mailing Address - Phone:864-714-5637
Mailing Address - Fax:
Practice Address - Street 1:300 JOHN ST UNIT 5B
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29651-1463
Practice Address - Country:US
Practice Address - Phone:864-714-5637
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty