Organization
PAVILLON GREENVILLE OUTPATIENT SERVICES
Active
Parent organization
PAVILLON INTERNATIONAL
Organization subpart
Yes
Provider details
NPI number
Legal business name
PAVILLON INTERNATIONAL
Authorized official
MS. NATALIE FRYAR LPC, CACII (PROGRAM MANAGER)
(864) 241-6688
Entity
Organization
Contact information
Practice address
101 PELHAM COMMONS BLVD, GREENVILLE, SC 29615-4974
(864) 241-6688
(864) 241-6682
Mailing address
101 PELHAM COMMONS BLVD, GREENVILLE, SC 29615-4974
(864) 241-6688
(864) 241-6682
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
OTP 0102
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1023345139
NPI
SC
Enumeration date
09/14/2012
Last updated
03/11/2015
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