Healthcare Provider Details

I. General information

NPI: 1598464166
Provider Name (Legal Business Name): YEW BELONG COMMUNITY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2023
Last Update Date: 03/03/2023
Certification Date: 03/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 BLACKHAWK CT
WEST COLUMBIA SC
29169-3712
US

IV. Provider business mailing address

105 BLACKHAWK CT
WEST COLUMBIA SC
29169-3712
US

V. Phone/Fax

Practice location:
  • Phone: 803-210-7422
  • Fax:
Mailing address:
  • Phone: 803-210-7422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DR. WENNDY NICOLE DUPKOSKI
Title or Position: DIRECTOR
Credential: PHD, LPC-S, LCMHC-S
Phone: 803-210-7422