Healthcare Provider Details

I. General information

NPI: 1841412061
Provider Name (Legal Business Name): CENTER FOR BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 01/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

182 LAURELHURST AVE
COLUMBIA SC
29210-3824
US

IV. Provider business mailing address

182 LAURELHURST AVE
COLUMBIA SC
29210-3824
US

V. Phone/Fax

Practice location:
  • Phone: 803-551-0060
  • Fax: 803-551-0062
Mailing address:
  • Phone: 803-551-0060
  • Fax: 803-551-0062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License Number154371
License Number StateSC

VIII. Authorized Official

Name: ANIL K JUNEJA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 803-551-0060