Individual
ELOISE W PEA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
211 BRIARCLIFF RD, SPARTANBURG, SC 29301-3017
(864) 804-6215
(864) 804-6238
Mailing address
PO BOX 1342, ROEBUCK, SC 29376-1342
(864) 612-3412
(864) 804-6238
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
90-0529220
—
SC
Enumeration date
04/19/2019
Last updated
04/19/2019
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