Healthcare Provider Details

I. General information

NPI: 1679325765
Provider Name (Legal Business Name): CRESCENT BEHAVIORAL HEALTH SERVICES, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2024
Last Update Date: 04/03/2024
Certification Date: 04/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 NORTHWOOD ST
COLUMBIA SC
29201-1533
US

IV. Provider business mailing address

PO BOX 5502
COLUMBIA SC
29250-5502
US

V. Phone/Fax

Practice location:
  • Phone: 803-467-2996
  • Fax:
Mailing address:
  • Phone: 803-467-2996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. RISLEY E LINDER
Title or Position: OWNER
Credential:
Phone: 803-467-2996