Organization
TABLE ROCK INTEGRATED HEALTH AND WELLNESS PRACTICE, LLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. GERGANA DAMIANOVA DIMITROVA M.D. (PARTNER)
(864) 908-6372
Entity
Organization
Contact information
Practice address
5 CENTER ST, TRAVELERS REST, SC 29690-1826
(864) 908-6372
(864) 898-3703
Mailing address
5 CENTER ST, TRAVELERS REST, SC 29690-1826
(864) 908-6372
(864) 898-3703
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
1223
SC
1041C0700X
Clinical Social Worker
5825
SC
2084P0800X
Psychiatry Physician
Primary
30719
SC
2084P0805X
Geriatric Psychiatry Physician
30719
SC
Other
Enumeration date
05/31/2010
Last updated
03/16/2020
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