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NPI Code Detail

MEDICARE: RAYLENE ROSS NCC, LPC, LCPC, LCMH

MEDICARE: RAYLENE ROSS NCC, LPC, LCPC, LCMH
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
1101YP2500XProfessional CounselorLC15161MD
2101YM0800XMental Health Counselor9595SC
3101YM0800XMental Health Counselor20444NC

General Provider Information

NPI Number : 1104567197
Entity Type Code : Individual
Provider Name (Legal Business Name) : RAYLENE ROSS NCC, LPC, LCPC, LCMH
Provider Business Mailing Address
First Line : 4500 FORT JACKSON BLVD STE 110
Second Line :
City : COLUMBIA
State : SC
Zip : 29209-1134
Country : US
Telephone Number : 803-386-8375
Fax Number :
Provider Business Practice Location Address
First Line : 4500 FORT JACKSON BLVD STE 110
Second Line :
City : COLUMBIA
State : SC
Zip : 29209-1134
Country : US
Telephone Number : 803-386-8375
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/05/2022
Last Update Date : 09/24/2025

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Directions to “ RAYLENE ROSS NCC, LPC, LCPC, LCMH” Practice Location

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