Healthcare Provider Details

I. General information

NPI: 1790510709
Provider Name (Legal Business Name): POSITIVE PATHWAYS COUNSELING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2024
Last Update Date: 09/09/2024
Certification Date: 09/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2417 CRAIG RD
COLUMBIA SC
29204-2632
US

IV. Provider business mailing address

2417 CRAIG RD
COLUMBIA SC
29204-2632
US

V. Phone/Fax

Practice location:
  • Phone: 803-403-7891
  • Fax:
Mailing address:
  • Phone: 803-403-7891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: LISA PURYEAR
Title or Position: OWNER
Credential: LPCS, LAC
Phone: 803-403-7891