Healthcare Provider Details

I. General information

NPI: 1972417608
Provider Name (Legal Business Name): KYIEA MONE BURCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 FAISON DR
COLUMBIA SC
29203-3210
US

IV. Provider business mailing address

400 OTARRE PKWY
CAYCE SC
29033-3751
US

V. Phone/Fax

Practice location:
  • Phone: 803-935-7143
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: