Provider Demographics
NPI:1528382165
Name:SPECTRUM FAMILY SOLUTIONS & CENTER FOR STRESS MANAGEMENT LLC
Entity Type:Organization
Organization Name:SPECTRUM FAMILY SOLUTIONS & CENTER FOR STRESS MANAGEMENT LLC
Other - Org Name:SPECTRUM FAMILY SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ESTHER
Authorized Official - Middle Name:STURDIVANT
Authorized Official - Last Name:GALLIESHAW
Authorized Official - Suffix:
Authorized Official - Credentials:EDS, NCC, LPC
Authorized Official - Phone:803-238-8852
Mailing Address - Street 1:PO BOX 4252
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29240-4252
Mailing Address - Country:US
Mailing Address - Phone:803-238-8852
Mailing Address - Fax:
Practice Address - Street 1:1816 BULL ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2506
Practice Address - Country:US
Practice Address - Phone:803-238-8852
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-25
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5149261QM0801X, 261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health