Provider Demographics
NPI:1356855837
Name:COLLABORATIVE MEANS, LLC
Entity Type:Organization
Organization Name:COLLABORATIVE MEANS, LLC
Other - Org Name:COLLABORATIVE MEANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LEAD COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JENAIS
Authorized Official - Middle Name:YVONNE
Authorized Official - Last Name:MEANS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:803-814-5573
Mailing Address - Street 1:3443 BUMGARDNER CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-2812
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4201 N MAIN ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-5863
Practice Address - Country:US
Practice Address - Phone:803-814-5573
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-20
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP9549Medicaid