# GREATER ALLIANCE BEHAVIORAL HEALTH

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1639851132
- **Authorized official:** CELENA NICOLE SHIVERS APRN PMHNP (OWNER)
- **Authorized official phone:** (803) 979-6171

## Contact information

- **Practice address:** 6037 LANDRY LN, INDIAN LAND, SC 29707-6060
- **Practice address phone:** (803) 979-6171
- **Practice address fax:** (704) 817-1470
- **Mailing address:** 8180 REGENT PKWY STE 109, FORT MILL, SC 29715-8417
- **Mailing address phone:** (803) 979-6171
- **Mailing address fax:** (704) 817-1470

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 163WP0808X | Psychiatric/Mental Health Registered Nurse | — | NULL | Yes |
| 163WP0808X | Psychiatric/Mental Health Registered Nurse | — | — | Yes |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 08/03/2023
- **Last updated:** 11/20/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1033828207 | NPI | — |