MEDICARE: CARLA L LANDES

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1821152554
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLA L LANDES

Provider Business Mailing Address
First Line	:	1800 COLONIAL DR
Second Line	:	COTTAGE A
City	:	COLUMBIA
State	:	SC
Zip	:	29203-6827
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	ENTIRE STATE
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29202
Country	:	US
Telephone Number	:	803-898-2025
Fax Number	:	803-898-2194

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

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	07/08/2007

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Directions to “ CARLA L LANDES ” Practice Location

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