Healthcare Provider Details

I. General information

NPI: 1336057223
Provider Name (Legal Business Name): CAMGREEN PSYCHIATRY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 MAIN ST STE 300
COLUMBIA SC
29201-3206
US

IV. Provider business mailing address

1320 MAIN ST STE 300
COLUMBIA SC
29201-3266
US

V. Phone/Fax

Practice location:
  • Phone: 803-590-0237
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: NIKKI RACQUEL SMITH
Title or Position: CEO
Credential: PMHNP
Phone: 803-590-0237