Provider Demographics
NPI:1629893201
Name:BELLA VITA PSYCHOTHERAPY GROUP, LLC
Entity type:Organization
Organization Name:BELLA VITA PSYCHOTHERAPY GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GAROFANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-201-3537
Mailing Address - Street 1:498 WANDO PARK BLVD.
Mailing Address - Street 2:SUITE 1003
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464
Mailing Address - Country:US
Mailing Address - Phone:843-608-0291
Mailing Address - Fax:
Practice Address - Street 1:498 WANDO PARK BLVD.
Practice Address - Street 2:SUITE 1003
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464
Practice Address - Country:US
Practice Address - Phone:803-201-3537
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-19
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty