| Organization Name: | TABLE ROCK INTEGRATED HEALTH AND WELLNESS PRACTICE, LLC. |
| NPI Number: | 1104145184 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | GERGANA DAMIANOVA DIMITROVA (PARTNER) |
| Mailing Address: | 5 Center St Travelers Rest |
| State: | SC US |
| Postal Code: | 296901826 |
| Phone Number: | 8649086372 |
| Fax Number: | 8648983703 |
| NPI Enumeration Date: | 05/31/2010 |
| NPI Last Update Date: | 02/29/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2084P0805X |
| License Number: | 30719 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | SC |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Psychiatry & Neurology |
| Taxonomy Specialization: | Geriatric Psychiatry |
| Taxonomy Definition: | Geriatric Psychiatry is a subspecialty with psychiatric expertise in prevention, evaluation, diagnosis and treatment of mental and emotional disorders in the elderly, and improvement of psychiatric care for healthy and ill elderly patients. |