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General NPI Number Information
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NPI Number | 1831511989
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Entity Type | Organization
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Legal Business Name | ENVISION WELLNESS MEDICAL GROUP
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Dates
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Enumeration Date | 01/08/2014
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Last Update Date | 01/08/2014
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Provider Practice Location Address
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Address Line | 2601 READ ST SUITE I-7
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City | COLUMBIA
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State | SC
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Zip | 29204-7861
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Country | US
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Telephone | 803-256-0101
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Fax | 800-854-3497
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Provider Business Mailing Address
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Address Line | 2601 READ ST SUITE I-7
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City | COLUMBIA
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State | SC
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Zip | 29204-7861
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Country | US
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Telephone | 803-256-0101
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Fax | 800-854-3497
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. ASHLEY FELDER
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Credential |
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Telephone | 803-256-0101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 22943
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License Number State | SC
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