Individual
VANISHA BENNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
305 SHADA LN, GREENVILLE, SC 29611-2068
(864) 887-6650
Mailing address
305 SHADA LN, GREENVILLE, SC 29611-2068
(864) 887-6650
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
06/15/2020
Last updated
06/15/2020
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