Organization
ROCK HILL VA
Active
Parent organization
VA
Organization subpart
Yes
Provider details
NPI number
Legal business name
VA
Authorized official
TAWNEY DIVELY (ADMINISTRATOR)
(803) 366-4848
Entity
Organization
Contact information
Practice address
205 PIEDMONT BLVD, ROCK HILL, SC 29732-1836
(803) 366-4848
Mailing address
205 PIEDMONT BLVD, ROCK HILL, SC 29732-1836
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
36
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
QMO740
—
SC
Enumeration date
09/30/2008
Last updated
09/30/2008
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