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General NPI Number Information
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NPI Number | 1902403116
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Entity Type | Organization
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Legal Business Name | PIECES 2 PEACE WELLNESS CENTER, LLC
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Dates
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Enumeration Date | 10/01/2020
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Last Update Date | 10/01/2020
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Provider Practice Location Address
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Address Line | 1105 BELLEVIEW ST STE 103
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City | COLUMBIA
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State | SC
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Zip | 29201-1839
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Country | US
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Telephone | 803-250-5198
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 9054
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City | COLUMBIA
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State | SC
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Zip | 29290-0054
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Country | US
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Telephone | 803-250-5198
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | MRS. ANNA B. GANTT-GORDON
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Credential | LPC
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Telephone | 803-250-5198
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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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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