Provider Demographics
NPI:1659912285
Name:ERVIN, TORY ADAM (LMFTA)
Entity type:Individual
Prefix:MR
First Name:TORY
Middle Name:ADAM
Last Name:ERVIN
Suffix:
Gender:M
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 VICTORY HL
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:SC
Mailing Address - Zip Code:29661-9419
Mailing Address - Country:US
Mailing Address - Phone:716-680-0628
Mailing Address - Fax:
Practice Address - Street 1:109 LAURENS RD STE 4D
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-1860
Practice Address - Country:US
Practice Address - Phone:864-214-5490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-04
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7067106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist