MEDICARE: OPEN MIND HEALTH SC LLC

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	:	1831047646
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPEN MIND HEALTH SC LLC

Provider Business Mailing Address
First Line	:	6650 RIVERS AVE STE 100
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406-4809
Country	:	US
Telephone Number	:	864-807-6209
Fax Number	:	864-807-6210

Provider Business Practice Location Address
First Line	:	6650 RIVERS AVE STE 100
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406-4809
Country	:	US
Telephone Number	:	864-905-7900
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	RAVIKUMAR PATEL
Credential	:
Telephone Number	:	864-807-6209

Provider Enumeration Date	:	03/18/2026
Last Update Date	:	05/27/2026

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