Table Rock Integrated Health and Wellness Practice, LLC.
NPI 1104145184ActiveOrganization· Psychiatry & Neurology, Psychiatry· Travelers Rest, SC
Psychiatry & Neurology, Psychiatry in Travelers Rest, South Carolina, registered in NPPES in May 2010. The authorized official on file is Gergana Damianova Dimitrova, M.D., Partner. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1104145184 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | May 31, 2010 |
| Last updated in NPPES | Mar 16, 2020 |
| Certified by provider | Mar 16, 2020 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Psychiatry & Neurology, Psychiatry Primary | 2084P0800X | 30719 | SC |
| Counselor, Professional | 101YP2500X | 1223 | SC |
| Social Worker, Clinical | 1041C0700X | 5825 | SC |
| Psychiatry & Neurology, Geriatric Psychiatry | 2084P0805X | 30719 | SC |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (SC) |
|---|
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