Healthcare Provider Details

I. General information

NPI: 1609386838
Provider Name (Legal Business Name): ROOTS PSYCHOLOGICAL ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2017
Last Update Date: 06/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1531 LAUREL ST
COLUMBIA SC
29201-2622
US

IV. Provider business mailing address

1531 LAUREL ST
COLUMBIA SC
29201-2622
US

V. Phone/Fax

Practice location:
  • Phone: 803-764-1010
  • Fax: 803-764-0193
Mailing address:
  • Phone: 803-764-1010
  • Fax: 803-764-0193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1412
License Number StateSC

VIII. Authorized Official

Name: DR. PATRICK JAMES STEELE
Title or Position: OWNER/LICENSED PSYCHOLOGIST
Credential: PSY.D.
Phone: 803-764-1010