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NPI Code Detail

MEDICARE: THE UNUMB CENTER FOR NEURODEVELOPMENT

MEDICARE: THE UNUMB CENTER FOR NEURODEVELOPMENT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist3640SC
2103T00000XPsychologist1319SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1023476280
Entity Type Code : Organization
Provider Name (Legal Business Name) : THE UNUMB CENTER FOR NEURODEVELOPMENT
Provider Business Mailing Address
First Line : 1505 BLANDING ST
Second Line :
City : COLUMBIA
State : SC
Zip : 29201-2906
Country : US
Telephone Number : 803-929-0011
Fax Number : 803-569-1054
Provider Business Practice Location Address
First Line : 1505 BLANDING ST
Second Line :
City : COLUMBIA
State : SC
Zip : 29201-2906
Country : US
Telephone Number : 803-929-0011
Fax Number : 803-569-1054
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : ANSLIE CALLAWAY PATRICK
Credential :
Telephone Number : 803-929-0011
Provider Enumeration Date : 02/03/2016
Last Update Date : 02/12/2021

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1184984742 — THE UNUMB CENTER FOR NEURODEVELOPMENT
Practice Location Address:
1505 BLANDING ST
COLUMBIA, SC
29201-2906
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Practice Fax: 803-569-1054
1629468491 — ALLISON BRAZENDALE PSY.D.
Practice Location Address:
1505 BLANDING ST
COLUMBIA, SC
29201-2906
Practice Phone: 954-913-6306
Practice Fax:
1407219165 — MR. CHRISTOPHER DEGRAFFENRIED KEENAN JR. BCBA
Practice Location Address:
1505 BLANDING ST
COLUMBIA, SC
29201-2906
Practice Phone: 803-929-0011
Practice Fax: 803-569-1054

Directions to “THE UNUMB CENTER FOR NEURODEVELOPMENT ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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