Organization
THE FIFTH SEASON CENTER FOR LOSS GRIEF AND TRANSITION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PATTIE S BRODERICK LISW (EXECUTIVE DIRECTOR)
(864) 404-5070
Entity
Organization
Contact information
Practice address
111 MILLS AVE, GREENVILLE, SC 29605-4017
(864) 241-8222
(864) 241-8222
Mailing address
111 MILLS AVE, GREENVILLE, SC 29605-4017
(864) 241-8222
(864) 241-8222
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
5150
SC
1041C0700X
Clinical Social Worker
Primary
1305
SC
Other
Enumeration date
06/30/2011
Last updated
09/06/2011
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