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General NPI Number Information
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NPI Number | 1609984236
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Entity Type | Organization
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Legal Business Name | NORTHEAST BEHAVIORAL HEALTHCARE INC
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Dates
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Enumeration Date | 08/25/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 120 A WILDEWOOD PARK DR
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City | COLUMBIA
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State | SC
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Zip | 29223
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Country | US
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Telephone | 803-360-1363
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Fax | 803-736-2452
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Provider Business Mailing Address
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Address Line | 224 SQUIRE RD
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City | COLUMBIA
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State | SC
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Zip | 29223
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Country | US
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Telephone | 803-360-1363
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Fax | 803-865-0596
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. NANCY B HYMAN
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Credential | LISW CP
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Telephone | 803-360-1363
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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