Healthcare Provider Details

I. General information

NPI: 1104017243
Provider Name (Legal Business Name): AIKEN PSYCHOTHERAPY AND COUNSELING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 08/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 VARDEN DR
AIKEN SC
29803-5285
US

IV. Provider business mailing address

33 VARDEN DR
AIKEN SC
29803-5285
US

V. Phone/Fax

Practice location:
  • Phone: 803-642-3801
  • Fax: 803-642-5538
Mailing address:
  • Phone: 803-642-3801
  • Fax: 803-642-5538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCMS22557
License Number StateSC

VIII. Authorized Official

Name: MRS. MICHELE J KNAPIK SMITH
Title or Position: PRESIDENT
Credential: APRN
Phone: 803-642-3801