Provider Demographics
NPI:1902450737
Name:THE JOURNEY BEHAVIORAL AND WELLNESS CLINIC, LLC
Entity Type:Organization
Organization Name:THE JOURNEY BEHAVIORAL AND WELLNESS CLINIC, LLC
Other - Org Name:THE JOURNEY BEHAVIORAL & WELLNESS CLINIC, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:TURBEVILLE
Authorized Official - Last Name:STUTTS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC, APRN
Authorized Official - Phone:843-687-6768
Mailing Address - Street 1:5825 CASTLECOVE RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-0500
Mailing Address - Country:US
Mailing Address - Phone:843-687-6768
Mailing Address - Fax:
Practice Address - Street 1:1456 EBENEZER RD
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-2339
Practice Address - Country:US
Practice Address - Phone:803-693-6100
Practice Address - Fax:803-746-0923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-30
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC19275OtherSC LICENSE