Healthcare Provider Details

I. General information

NPI: 1386028512
Provider Name (Legal Business Name): MENTAL HEALTH AMERICA SOUTH CAROLINA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2015
Last Update Date: 07/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1823 GADSDEN ST
COLUMBIA SC
29201-2344
US

IV. Provider business mailing address

1823 GADSDEN ST
COLUMBIA SC
29201-2344
US

V. Phone/Fax

Practice location:
  • Phone: 803-779-5363
  • Fax:
Mailing address:
  • Phone: 803-779-5363
  • Fax: 803-929-6147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JOY JAY
Title or Position: DIRECTOR
Credential:
Phone: 803-779-5363