Healthcare Provider Details

I. General information

NPI: 1437195963
Provider Name (Legal Business Name): FAMILY MATTERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 09/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2016 ASSEMBLY ST
COLUMBIA SC
29201-2142
US

IV. Provider business mailing address

PO BOX 8561
COLUMBIA SC
29202-8561
US

V. Phone/Fax

Practice location:
  • Phone: 803-251-0368
  • Fax:
Mailing address:
  • Phone: 803-251-0368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number4056
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number4056
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number4056
License Number StateSC

VIII. Authorized Official

Name: DR. NICOLE WILLIS SNELL
Title or Position: OWNER
Credential: LPC
Phone: 803-251-0368