Healthcare Provider Details

I. General information

NPI: 1821255050
Provider Name (Legal Business Name): CAROLINA COUNSELING AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2008
Last Update Date: 06/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1333 TAYLOR ST SUITE 4H
COLUMBIA SC
29201-2923
US

IV. Provider business mailing address

1333 TAYLOR ST SUITE 4H
COLUMBIA SC
29201-2923
US

V. Phone/Fax

Practice location:
  • Phone: 803-779-7500
  • Fax: 803-779-7522
Mailing address:
  • Phone: 803-779-7500
  • Fax: 803-779-7522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number17355
License Number StateSC

VIII. Authorized Official

Name: DR. TIMOTHY D. MALONE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 803-779-7500