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General NPI Number Information
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NPI Number | 1073560264
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Entity Type | Organization
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Legal Business Name | COLUMBIA COUNSELING CENTER/COLUMBIA BEHAVIORAL MEDICINE, P.A.
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Dates
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Enumeration Date | 05/31/2006
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Last Update Date | 10/09/2024
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Provider Practice Location Address
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Address Line | 900 SAINT ANDREWS RD
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City | COLUMBIA
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State | SC
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Zip | 29210-5816
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Country | US
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Telephone | 803-731-4708
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Fax | 803-612-1206
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Provider Business Mailing Address
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Address Line | 900 SAINT ANDREWS RD
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City | COLUMBIA
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State | SC
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Zip | 29210-5816
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Country | US
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Telephone | 803-731-4708
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Fax | 803-612-1206
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. DARREL GENE SHAVER
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Credential | PH.D., LPC
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Telephone | 803-731-4708
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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