Organization
ALL ABOUT CHANGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY ROSEBERRY (EXECUTIVE DIRECTOR)
(864) 704-0931
Entity
Organization
Contact information
Practice address
850 WADE HAMPTON BLVD, SUITE C, GREENVILLE, SC 29609-4945
(864) 704-0931
Mailing address
850 WADE HAMPTON BLVD, SUITE C, GREENVILLE, SC 29609-4945
(864) 704-0931
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
5080
SC
106H00000X
Marriage & Family Therapist
Primary
4497
SC
Other
Enumeration date
10/02/2012
Last updated
10/02/2012
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