Provider Demographics
NPI:1639851132
Name:GREATER ALLIANCE BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:GREATER ALLIANCE BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CELENA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:SHIVERS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN PMHNP
Authorized Official - Phone:803-979-6171
Mailing Address - Street 1:8180 REGENT PKWY STE 109
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29715-8417
Mailing Address - Country:US
Mailing Address - Phone:803-979-6171
Mailing Address - Fax:704-817-1470
Practice Address - Street 1:6037 LANDRY LN
Practice Address - Street 2:
Practice Address - City:INDIAN LAND
Practice Address - State:SC
Practice Address - Zip Code:29707-6060
Practice Address - Country:US
Practice Address - Phone:803-979-6171
Practice Address - Fax:704-817-1470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-03
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Single Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1033828207OtherNPI