Healthcare Provider Details

I. General information

NPI: 1205275310
Provider Name (Legal Business Name): MEREDITH MEGAN DILLON MAGINNIS BSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2013
Last Update Date: 11/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1421 BLUFF RD
COLUMBIA SC
29201-4809
US

IV. Provider business mailing address

205 SILVER LAKE RD E
COLUMBIA SC
29223-2908
US

V. Phone/Fax

Practice location:
  • Phone: 803-733-5855
  • Fax: 803-733-5892
Mailing address:
  • Phone: 662-380-2424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: