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General NPI Number Information
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NPI Number | 1154892099
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Entity Type | Organization
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Legal Business Name | OMEGA PSYCHIATRIC SOLUTIONS
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Dates
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Enumeration Date | 12/17/2018
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Last Update Date | 07/15/2020
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Provider Practice Location Address
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Address Line | 1735 SAINT JULIAN PL STE 102
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City | COLUMBIA
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State | SC
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Zip | 29204-2402
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Country | US
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Telephone | 803-497-9611
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Fax | 803-353-3622
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Provider Business Mailing Address
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Address Line | 1735 SAINT JULIAN PL STE 102
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City | COLUMBIA
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State | SC
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Zip | 29204-2402
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Country | US
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Telephone | 803-497-9611
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Fax | 803-764-2003
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Authorized Official
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Title or Position | CO-OWNER
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Name | MRS. KIM J GILMORE
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Credential | PMCNS, ANP
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Telephone | 803-497-9611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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