Healthcare Provider Details

I. General information

NPI: 1871406124
Provider Name (Legal Business Name): SUCCESS CAROLINA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 GARDEN VIEW DR
WEST COLUMBIA SC
29169-6257
US

IV. Provider business mailing address

213 GARDEN VIEW DR
WEST COLUMBIA SC
29169-6257
US

V. Phone/Fax

Practice location:
  • Phone: 803-678-7950
  • Fax:
Mailing address:
  • Phone: 803-678-7950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: PAWEL ROMAN POTYLICKI
Title or Position: OWNER
Credential: LPC, MS
Phone: 803-678-7950