Individual
JAVONIA DE'ANTASIA GARY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
205 FARRS BRIDGE RD, GREENVILLE, SC 29617-1905
(864) 383-0384
Mailing address
16 ARRINGTON AVE, GREENVILLE, SC 29617-7842
(843) 345-1944
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
9113
SC
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
08/30/2023
Last updated
04/02/2026
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