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General NPI Number Information
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NPI Number | 1366130692
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Entity Type | Organization
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Legal Business Name | GOLDEN SHIELDS THERAPEUTICS & COMMUNITY SERVICES
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Dates
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Enumeration Date | 04/25/2023
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Last Update Date | 08/01/2023
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Provider Practice Location Address
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Address Line | 2625 RUTLEDGE ST
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City | COLUMBIA
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State | SC
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Zip | 29204-2520
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Country | US
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Telephone | 770-380-8994
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Fax | 803-834-4370
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Provider Business Mailing Address
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Address Line | 2625 RUTLEDGE ST
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City | COLUMBIA
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State | SC
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Zip | 29204-2520
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Country | US
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Telephone | 770-380-8994
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Fax | 803-834-4370
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Authorized Official
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Title or Position | CEO
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Name | JOHNNIE C HARDY
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Credential |
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Telephone | 770-380-8994
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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