Healthcare Provider Details

I. General information

NPI: 1659543262
Provider Name (Legal Business Name): AIKEN PSYCHOTHERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2008
Last Update Date: 05/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 VARDEN DR
AIKEN SC
29803-5285
US

IV. Provider business mailing address

PO BOX 7337 33VARDEN DRIVE
AIKEN SC
29804-7337
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 TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberAPN567
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberAPN567
License Number StateSC

VIII. Authorized Official

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