Organization
GREATER ALLIANCE BEHAVIORAL HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CELENA NICOLE SHIVERS APRN PMHNP (OWNER)
(803) 979-6171
Entity
Organization
Contact information
Practice address
6037 LANDRY LN, INDIAN LAND, SC 29707-6060
(803) 979-6171
(704) 817-1470
Mailing address
8180 REGENT PKWY STE 109, FORT MILL, SC 29715-8417
(803) 979-6171
(704) 817-1470
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1033828207
NPI
—
Enumeration date
08/03/2023
Last updated
11/20/2023
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