Healthcare Provider Details

I. General information

NPI: 1831651587
Provider Name (Legal Business Name): COLUMBIA LACTATION CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2019
Last Update Date: 12/15/2022
Certification Date: 12/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 COLUMBIANA DR STE 116
IRMO SC
29063-7782
US

IV. Provider business mailing address

800 COLUMBIANA DR STE 116
IRMO SC
29063-7782
US

V. Phone/Fax

Practice location:
  • Phone: 803-250-5723
  • Fax: 803-598-0100
Mailing address:
  • Phone: 803-250-5723
  • Fax: 803-598-0100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State

VIII. Authorized Official

Name: KRISTYN LEONARD
Title or Position: OWNER
Credential:
Phone: 803-319-7127