Healthcare Provider Details

I. General information

NPI: 1760903918
Provider Name (Legal Business Name): PROGRESSIVE LIFE CHANGERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2017
Last Update Date: 05/13/2020
Certification Date: 05/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 BELLEVIEW ST STE 103
COLUMBIA SC
29201-1863
US

IV. Provider business mailing address

1101 BELLEVIEW ST STE 103
COLUMBIA SC
29201-1863
US

V. Phone/Fax

Practice location:
  • Phone: 704-726-2590
  • Fax: 980-422-0161
Mailing address:
  • Phone: 704-726-2590
  • Fax: 980-422-0161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State

VIII. Authorized Official

Name: KENNETH O'BRYAN CURLEE
Title or Position: OWNER
Credential:
Phone: 704-726-2590