=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700625860
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COLUMBIA COUNSELING CENTER AND ASSOCIATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/20/2024
-----------------------------------------------------
Last Update Date | 05/20/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 900 SAINT ANDREWS RD
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29210-5816
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-731-4708
-----------------------------------------------------
Fax | 803-612-1206
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 900 SAINT ANDREWS RD
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29210-5816
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-731-4708
-----------------------------------------------------
Fax | 803-612-1206
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/OWNER
-----------------------------------------------------
Name | HEATHER BEDFORD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 803-731-4708
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------