Provider Demographics
NPI:1013056100
Name:GREENVILLE THERAPY CENTER PA
Entity Type:Organization
Organization Name:GREENVILLE THERAPY CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DODIE
Authorized Official - Middle Name:SHREE
Authorized Official - Last Name:YONGUE
Authorized Official - Suffix:
Authorized Official - Credentials:LISW CP LMFT
Authorized Official - Phone:864-234-6778
Mailing Address - Street 1:3519 PELHAM ROAD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615
Mailing Address - Country:US
Mailing Address - Phone:864-234-6778
Mailing Address - Fax:864-234-2474
Practice Address - Street 1:3519 PELHAM ROAD
Practice Address - Street 2:SUITE 103
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615
Practice Address - Country:US
Practice Address - Phone:864-234-6778
Practice Address - Fax:864-234-2474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
6193Medicare UPIN