Healthcare Provider Details

I. General information

NPI: 1861225450
Provider Name (Legal Business Name): EXQUISITE MINDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2024
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 RICE BENT WAY STE 11
COLUMBIA SC
29229-6850
US

IV. Provider business mailing address

830 WEEKS ST
SUMTER SC
29150-6740
US

V. Phone/Fax

Practice location:
  • Phone: 803-962-8621
  • Fax:
Mailing address:
  • Phone: 803-962-8621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. TIFFANY D JOHNSON
Title or Position: OWNER,PROVIDER
Credential: LPC
Phone: 803-962-5326