Provider Demographics
NPI:1609267822
Name:PALMETTO COMPREHENSIVE BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:PALMETTO COMPREHENSIVE BEHAVIORAL HEALTH
Other - Org Name:PCBH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAKA
Authorized Official - Middle Name:ABDUL
Authorized Official - Last Name:MOUSTAFA
Authorized Official - Suffix:I
Authorized Official - Credentials:PHD
Authorized Official - Phone:803-477-7928
Mailing Address - Street 1:108 CAUGHMAN RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29209-3114
Mailing Address - Country:US
Mailing Address - Phone:803-477-7928
Mailing Address - Fax:
Practice Address - Street 1:108 CAUGHMAN RIDGE RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209-3114
Practice Address - Country:US
Practice Address - Phone:803-477-7928
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-10
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health