Healthcare Provider Details

I. General information

NPI: 1689842817
Provider Name (Legal Business Name): FAMILY MATTERS PSYCHOTHERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2008
Last Update Date: 02/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 1/2 CALHOUN ST
COLUMBIA SC
29201-2509
US

IV. Provider business mailing address

1401 1/2 CALHOUN ST
COLUMBIA SC
29201-2509
US

V. Phone/Fax

Practice location:
  • Phone: 803-376-2994
  • Fax:
Mailing address:
  • Phone: 803-376-2994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number4056
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4056
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number4056
License Number StateSC

VIII. Authorized Official

Name: MR. BRIAN CHRISTOPHER SNELL
Title or Position: OFFICE MANAGER
Credential:
Phone: 803-309-8896