Healthcare Provider Details

I. General information

NPI: 1811220569
Provider Name (Legal Business Name): COLUMBIA AREA MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2009
Last Update Date: 10/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 COLONIAL DR
COLUMBIA SC
29203-6827
US

IV. Provider business mailing address

1800 COLONIAL DR
COLUMBIA SC
29203-6827
US

V. Phone/Fax

Practice location:
  • Phone: 803-898-1306
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MELVIN EVERAROD MALONE JR.
Title or Position: CASE MANAGER
Credential:
Phone: 803-609-4132