Healthcare Provider Details

I. General information

NPI: 1184984742
Provider Name (Legal Business Name): THE UNUMB CENTER FOR NEURODEVELOPMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2012
Last Update Date: 06/20/2025
Certification Date: 06/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 BLANDING ST
COLUMBIA SC
29201-2906
US

IV. Provider business mailing address

PO BOX 7514
COLUMBIA SC
29202-7514
US

V. Phone/Fax

Practice location:
  • Phone: 803-929-0011
  • Fax: 803-569-1054
Mailing address:
  • Phone: 803-790-7997
  • Fax: 803-520-6531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JESSICA HUDSON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 803-521-4077