Provider Demographics
NPI:1437502531
Name:STARS OF SC
Entity Type:Organization
Organization Name:STARS OF SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:WEAVER
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-261-8606
Mailing Address - Street 1:780 FASHION DR
Mailing Address - Street 2:SUITE 3103
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-7935
Mailing Address - Country:US
Mailing Address - Phone:803-261-8606
Mailing Address - Fax:
Practice Address - Street 1:780 FASHION DR
Practice Address - Street 2:SUITE 3103
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-7935
Practice Address - Country:US
Practice Address - Phone:803-261-8606
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-13
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Multi-Specialty