Healthcare Provider Details

I. General information

NPI: 1073560264
Provider Name (Legal Business Name): COLUMBIA COUNSELING CENTER/COLUMBIA BEHAVIORAL MEDICINE, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 SAINT ANDREWS RD
COLUMBIA SC
29210-5816
US

IV. Provider business mailing address

900 SAINT ANDREWS RD
COLUMBIA SC
29210-5816
US

V. Phone/Fax

Practice location:
  • Phone: 803-731-4708
  • Fax: 803-612-1206
Mailing address:
  • Phone: 803-731-4708
  • Fax: 803-612-1206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. DARREL GENE SHAVER
Title or Position: PRESIDENT
Credential: PH.D., LPC
Phone: 803-731-4708