Healthcare Provider Details

I. General information

NPI: 1023476280
Provider Name (Legal Business Name): THE UNUMB CENTER FOR NEURODEVELOPMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2016
Last Update Date: 02/12/2021
Certification Date: 02/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 BLANDING ST
COLUMBIA SC
29201-2906
US

IV. Provider business mailing address

1505 BLANDING ST
COLUMBIA SC
29201-2906
US

V. Phone/Fax

Practice location:
  • Phone: 803-929-0011
  • Fax: 803-569-1054
Mailing address:
  • Phone: 803-929-0011
  • Fax: 803-569-1054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1319
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number3640
License Number StateSC

VIII. Authorized Official

Name: ANSLIE CALLAWAY PATRICK
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 803-929-0011