Healthcare Provider Details

I. General information

NPI: 1699157362
Provider Name (Legal Business Name): SHE'S COUNSELING TRICHOLOGY & CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2015
Last Update Date: 05/30/2024
Certification Date: 05/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2638 TWO NOTCH RD SUITE 210
COLUMBIA SC
29204
US

IV. Provider business mailing address

2638 TWO NOTCH RD SUITE 210
COLUMBIA SC
29204
US

V. Phone/Fax

Practice location:
  • Phone: 803-936-1550
  • Fax: 803-306-6848
Mailing address:
  • Phone: 803-638-3535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6471
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number6027
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberDE3780
License Number StateSC
# 4
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License NumberDE3780
License Number StateSC
# 5
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: RODSHENNA GANZY
Title or Position: CEO/LICENSED CLINICAL THERAPIST SUP
Credential:
Phone: 803-546-3896