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General NPI Number Information
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NPI Number | 1801205265
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Entity Type | Organization
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Legal Business Name | GOOD KIDS INC
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Dates
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Enumeration Date | 08/10/2014
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Last Update Date | 08/10/2014
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Provider Practice Location Address
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Address Line | 5203 N MAIN ST
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City | COLUMBIA
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State | SC
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Zip | 29203-4520
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Country | US
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Telephone | 803-216-5397
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Fax |
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Provider Business Mailing Address
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Address Line | 112 BEAVER CREEK DR
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City | COLUMBIA
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State | SC
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Zip | 29223-7750
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | ROBERT WYLIE
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Credential |
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Telephone | 803-530-0277
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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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 | 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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