Provider Demographics
NPI:1265802821
Name:BALENTINE, LAURA JOHNSON (BA)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:JOHNSON
Last Name:BALENTINE
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 EXECUTIVE DR
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29651-1244
Mailing Address - Country:US
Mailing Address - Phone:864-879-2111
Mailing Address - Fax:864-848-9493
Practice Address - Street 1:220 EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29651-1244
Practice Address - Country:US
Practice Address - Phone:864-879-2111
Practice Address - Fax:864-848-9493
Is Sole Proprietor?:No
Enumeration Date:2015-09-25
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker