MEDICARE: CONSTANTS ADAMS LPC

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	5649	SC

General Provider Information

NPI Number	:	1861816522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CONSTANTS ADAMS LPC

Provider Business Mailing Address
First Line	:	3800 FOREST DR
Second Line	:	C 101
City	:	COLUMBIA
State	:	SC
Zip	:	29204-4146
Country	:	US
Telephone Number	:	803-403-8469
Fax Number	:	803-403-9979

Provider Business Practice Location Address
First Line	:	3800 FOREST DR
Second Line	:	C 101
City	:	COLUMBIA
State	:	SC
Zip	:	29204-4146
Country	:	US
Telephone Number	:	803-403-8469
Fax Number	:	803-403-9979

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

Provider Enumeration Date	:	02/14/2014
Last Update Date	:	02/14/2014

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