Healthcare Provider Details

I. General information

NPI: 1285307546
Provider Name (Legal Business Name): TRANSITIONING NORTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2021
Last Update Date: 07/31/2021
Certification Date: 07/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1917 MITCHELL ST
COLUMBIA SC
29205-4301
US

IV. Provider business mailing address

1917 MITCHELL ST
COLUMBIA SC
29205-4301
US

V. Phone/Fax

Practice location:
  • Phone: 202-415-9085
  • Fax:
Mailing address:
  • Phone: 202-415-9085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. SHAMBRICKA DENISE NORTH
Title or Position: OWNER
Credential: LISW-CP
Phone: 202-415-9085