Basic Information
Provider Information
NPI: 1922104793
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RAPP
FirstName: DELORIS
MiddleName: GARRETT
NamePrefix:  
NameSuffix:  
Credential: M.DIV
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1547 PARKWAY
Address2: SUITE 100
City: GREENWOOD
State: SC
PostalCode: 296464081
CountryCode: US
TelephoneNumber: 8642297120
FaxNumber: 8642295526
Practice Location
Address1: 6979 SC HIGHWAY 28 S
Address2:  
City: MC CORMICK
State: SC
PostalCode: 298357649
CountryCode: US
TelephoneNumber: 8644432243
FaxNumber: 8644433298
Other Information
ProviderEnumerationDate: 09/16/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800X  Y Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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