Organization
PERSONAL HEALING AND MENTORING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TRAVIS THOMPSON (CHIEF EXECUTIVE OFFICER)
(843) 619-8872
Entity
Organization
Contact information
Practice address
8887 OLD UNIVERSITY BLVD, NORTH CHARLESTON, SC 29406-7123
(843) 619-8872
Mailing address
109 HICKORY RIDGE WAY, SUMMERVILLE, SC 29483-9759
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
06/22/2022
Last updated
06/22/2022
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