42D2057610 CLIA NUMBER - SOUTHERN PSYCHIATRIC PRACTICE

Laboratory Demographics

  • CLIA Code: 42D2057610
  • Facility Name: SOUTHERN PSYCHIATRIC PRACTICE
  • Facility Address: 2424 INDIA HOOK ROAD, SUITE 120
    ROCK HILL, SC
    ZIP 29732
  • Facility Phone: 803 328-8255
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: TAMMY T. CHEN
  • NPI Number: 1578807483
  • Taxonomy: 261QM0801X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 42D2057610
LAB Type Physician Office
Facility Name SOUTHERN PSYCHIATRIC PRACTICE
Street 2424 INDIA HOOK ROAD, SUITE 120
City ROCK HILL
State SC
ZIP 29732
Phone 803 328-8255
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/4/2025
Certificate Expiration Date 3/3/2027
Facility Type Physician Office
Lab Director TAMMY T. CHEN

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This page was last updated on: 9/29/2025