MEDICARE: WILLIAM CLYDE HARRIS

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1114983459
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM CLYDE HARRIS

Provider Business Mailing Address
First Line	:	2711 COLONIAL DR
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29203-6818
Country	:	US
Telephone Number	:	706-542-9700
Fax Number	:	706-542-9693

Provider Business Practice Location Address
First Line	:	2711 COLONIAL DR
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29203-6818
Country	:	US
Telephone Number	:	706-542-9700
Fax Number	:	706-542-9693

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2006
Last Update Date	:	10/05/2016

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