Provider Demographics
NPI:1962001321
Name:FUTURE GEMS GREENVILLE ENTREPRENEUR MENTORSHIP
Entity type:Organization
Organization Name:FUTURE GEMS GREENVILLE ENTREPRENEUR MENTORSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TAMIKA
Authorized Official - Middle Name:T
Authorized Official - Last Name:STEVENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-671-2311
Mailing Address - Street 1:133 ARNOLD MILL RD
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29680-7293
Mailing Address - Country:US
Mailing Address - Phone:267-671-2311
Mailing Address - Fax:864-412-7989
Practice Address - Street 1:133 ARNOLD MILL RD
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29680-7293
Practice Address - Country:US
Practice Address - Phone:267-671-2311
Practice Address - Fax:864-412-7989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-17
Last Update Date:2020-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM1100XAmbulatory Health Care FacilitiesClinic/CenterMilitary/U.S. Coast Guard Outpatient
No347C00000XTransportation ServicesPrivate Vehicle