Healthcare Provider Details

I. General information

NPI: 1982975439
Provider Name (Legal Business Name): ONEDAYMAMA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2012
Last Update Date: 01/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 ALPINE CIR
COLUMBIA SC
29223-6385
US

IV. Provider business mailing address

3430 LYLES ST
COLUMBIA SC
29201-1323
US

V. Phone/Fax

Practice location:
  • Phone: 803-779-3548
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5266
License Number StateSC

VIII. Authorized Official

Name: ELIZABETH DUKES
Title or Position: MENTAL HEALTH THERAPIST
Credential: LPC
Phone: 803-312-5999