MEDICARE: MILITARY FAMILY SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	103TC1900X	Counseling Psychologist
2	1041C0700X	Clinical Social Worker
3	106H00000X	Marriage & Family Therapist
4	261QV0200X	VA Clinic/Center
5	101YM0800X	Mental Health Counselor
6	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1063765725
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILITARY FAMILY SERVICES

Provider Business Mailing Address
First Line	:	2879 HIGHWAY 160 W STE 4388
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29708-8581
Country	:	US
Telephone Number	:	803-792-7178
Fax Number	:	803-675-5233

Provider Business Practice Location Address
First Line	:	6510 STROM THURMOND BLVD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29207-5202
Country	:	US
Telephone Number	:	803-792-7178
Fax Number	:	803-675-5233

Authorized Official
Title or Position	:	OWNER/DIRECTOR
Name	:	MICHELLE DOLPHUS
Credential	:
Telephone Number	:	803-792-7178

Provider Enumeration Date	:	10/18/2012
Last Update Date	:	12/03/2012

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