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NPI Code Detail

MEDICARE: GOLDEN SHIELDS THERAPEUTICS & COMMUNITY SERVICES

MEDICARE: GOLDEN SHIELDS THERAPEUTICS & COMMUNITY SERVICES
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
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number : 1366130692
Entity Type Code : Organization
Provider Name (Legal Business Name) : GOLDEN SHIELDS THERAPEUTICS & COMMUNITY SERVICES
Provider Business Mailing Address
First Line : 2625 RUTLEDGE ST
Second Line :
City : COLUMBIA
State : SC
Zip : 29204-2520
Country : US
Telephone Number : 770-380-8994
Fax Number : 803-834-4370
Provider Business Practice Location Address
First Line : 2625 RUTLEDGE ST
Second Line :
City : COLUMBIA
State : SC
Zip : 29204-2520
Country : US
Telephone Number : 770-380-8994
Fax Number : 803-834-4370
Authorized Official
Title or Position : CEO
Name : JOHNNIE C HARDY
Credential :
Telephone Number : 770-380-8994
Provider Enumeration Date : 04/25/2023
Last Update Date : 08/01/2023

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Directions to “GOLDEN SHIELDS THERAPEUTICS & COMMUNITY SERVICES ” Practice Location

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