Provider Demographics
NPI:1659543262
Name:AIKEN PSYCHOTHERAPY
Entity Type:Organization
Organization Name:AIKEN PSYCHOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:J
Authorized Official - Last Name:KNAPIK-SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:803-642-3801
Mailing Address - Street 1:PO BOX 7337
Mailing Address - Street 2:33VARDEN DRIVE
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29804-7337
Mailing Address - Country:US
Mailing Address - Phone:803-642-3801
Mailing Address - Fax:803-642-5538
Practice Address - Street 1:33 VARDEN DR
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-5285
Practice Address - Country:US
Practice Address - Phone:803-642-3801
Practice Address - Fax:803-642-5538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-25
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPN567251S00000X, 364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP1019Medicaid
SC7256Medicare PIN