Healthcare Provider Details

I. General information

NPI: 1942530233
Provider Name (Legal Business Name): MENTAL HEALTH AMERICA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2010
Last Update Date: 01/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 CLAUDE BUNDRICK RD
BLYTHEWOOD SC
29016
US

IV. Provider business mailing address

117 WOODLANDS VILLAGE DR
COLUMBIAS SC
29229
US

V. Phone/Fax

Practice location:
  • Phone: 803-754-5478
  • Fax:
Mailing address:
  • Phone: 803-261-9320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number320800000X
License Number StateSC

VIII. Authorized Official

Name: MRS. KIMBERLY HUNTER
Title or Position: DIRECTOR
Credential: AMINSTRATIVE ASSIST
Phone: 803-754-5478