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General NPI Number Information
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NPI Number | 1598117152
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Entity Type | Organization
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Legal Business Name | EMERGE ESSENTIALS, LLC
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Dates
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Enumeration Date | 07/07/2016
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Last Update Date | 07/07/2016
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Provider Practice Location Address
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Address Line | 1612 MARION ST SUITE 313
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City | COLUMBIA
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State | SC
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Zip | 29201-2939
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Country | US
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Telephone | 803-298-8356
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Fax |
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Provider Business Mailing Address
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Address Line | 1612 MARION ST SUITE 313
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City | COLUMBIA
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State | SC
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Zip | 29201-2939
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Country | US
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Telephone | 803-298-8356
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Fax |
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR/CEO
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Name | MS. MICHELLE G DRAYTON
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Credential | LPCS, CSPC, CSSC
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Telephone | 803-238-5063
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS1200X
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Taxonomy Name | Sleep Disorder Diagnostic Clinic/Center
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License Number | 5337
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License Number State | SC
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Taxonomy #2
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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 | 5337
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License Number State | SC
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