Healthcare Provider Details

I. General information

NPI: 1457122715
Provider Name (Legal Business Name): VINCENT YLAGAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2024
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3012 MILLWOOD AVE
COLUMBIA SC
29205-1807
US

IV. Provider business mailing address

3012 MILLWOOD AVE
COLUMBIA SC
29205-1807
US

V. Phone/Fax

Practice location:
  • Phone: 803-392-3474
  • Fax: 843-363-2460
Mailing address:
  • Phone: 803-392-3474
  • Fax: 843-363-2460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number12591
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number12591
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number12591
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: