Healthcare Provider Details

I. General information

NPI: 1063765725
Provider Name (Legal Business Name): MILITARY FAMILY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2012
Last Update Date: 12/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6510 STROM THURMOND BLVD
COLUMBIA SC
29207-5202
US

IV. Provider business mailing address

2879 HIGHWAY 160 W STE 4388
FORT MILL SC
29708-8581
US

V. Phone/Fax

Practice location:
  • Phone: 803-792-7178
  • Fax: 803-675-5233
Mailing address:
  • Phone: 803-792-7178
  • Fax: 803-675-5233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QV0200X
TaxonomyVA Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE DOLPHUS
Title or Position: OWNER/DIRECTOR
Credential:
Phone: 803-792-7178