Healthcare Provider Details

I. General information

NPI: 1114983459
Provider Name (Legal Business Name): WILLIAM CLYDE HARRIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 10/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2711 COLONIAL DR
COLUMBIA SC
29203-6818
US

IV. Provider business mailing address

2711 COLONIAL DR
COLUMBIA SC
29203-6818
US

V. Phone/Fax

Practice location:
  • Phone: 706-542-9700
  • Fax: 706-542-9693
Mailing address:
  • Phone: 706-542-9700
  • Fax: 706-542-9693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: