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General NPI Number Information
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NPI Number | 1871406124
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Entity Type | Organization
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Legal Business Name | SUCCESS CAROLINA, LLC
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Dates
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Enumeration Date | 09/28/2026
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Last Update Date | 09/28/2026
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Provider Practice Location Address
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Address Line | 213 GARDEN VIEW DR
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City | WEST COLUMBIA
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State | SC
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Zip | 29169-6257
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Country | US
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Telephone | 803-678-7950
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Fax |
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Provider Business Mailing Address
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Address Line | 213 GARDEN VIEW DR
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City | WEST COLUMBIA
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State | SC
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Zip | 29169-6257
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Country | US
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Telephone | 803-678-7950
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | PAWEL ROMAN POTYLICKI
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Credential | LPC, MS
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Telephone | 803-678-7950
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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 | NULL
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