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Organization
BLUE HERON WELLNESS LLC
Active
Organization
BLUE HERON WELLNESS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RENEA CHRISTINE MABLE LISW-CP (OWNER)
(803) 429-9065
Entity
Organization
Contact information
Practice address
719 S LAKE DR, LEXINGTON, SC 29072-3432
(803) 609-7792
(803) 816-9058
Mailing address
419 FIREBRIDGE DR, CHAPIN, SC 29036-7639
(803) 429-9065
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
10640
SC
Other
Enumeration date
05/17/2018
Last updated
07/20/2021
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