Healthcare Provider Details

I. General information

NPI: 1497569941
Provider Name (Legal Business Name): AUTHENTICALLY ALIGNED LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2025
Last Update Date: 02/05/2025
Certification Date: 01/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

362 PINELAND RD.
VANCE SC
29163
US

IV. Provider business mailing address

123 BRICKINGHAM WAY
COLUMBIA SC
29229-8782
US

V. Phone/Fax

Practice location:
  • Phone: 803-542-9665
  • Fax:
Mailing address:
  • Phone: 803-629-0419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. SANDREA LASHAY HALL LAWTON
Title or Position: CASE MANAGER
Credential:
Phone: 803-629-0419