Healthcare Provider Details

I. General information

NPI: 1528974458
Provider Name (Legal Business Name): HENRY MCFADDEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 BELLEVIEW ST STE 101
COLUMBIA SC
29201-1884
US

IV. Provider business mailing address

PO BOX 8724
COLUMBIA SC
29202-8724
US

V. Phone/Fax

Practice location:
  • Phone: 803-740-9298
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1904043
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: