Provider Demographics
NPI:1598354300
Name:PRISM REFLECTIONS LLC
Entity Type:Organization
Organization Name:PRISM REFLECTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF ENTITY
Authorized Official - Prefix:
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:D
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, APRN, PMHNP-BC
Authorized Official - Phone:803-201-3078
Mailing Address - Street 1:111 SOUTHWELL RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-4480
Mailing Address - Country:US
Mailing Address - Phone:803-201-3078
Mailing Address - Fax:803-678-4260
Practice Address - Street 1:6156 SAINT ANDREWS RD STE 105
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29212-3147
Practice Address - Country:US
Practice Address - Phone:803-201-3078
Practice Address - Fax:803-678-4260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-15
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty