Healthcare Provider Details

I. General information

NPI: 1568918761
Provider Name (Legal Business Name): JOSE E MONTOYA LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2016
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date: 06/17/2026
Reactivation Date: 07/27/2026

III. Provider practice location address

520 GALWAY LN
COLUMBIA SC
29209-2013
US

IV. Provider business mailing address

520 GALWAY LN
COLUMBIA SC
29209-2013
US

V. Phone/Fax

Practice location:
  • Phone: 336-944-2554
  • Fax:
Mailing address:
  • Phone: 336-944-2554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904010652
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberI.2507607
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP010798
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: