Provider Demographics
NPI:1689677700
Name:DANIEL PISTONE, MD PA
Entity Type:Organization
Organization Name:DANIEL PISTONE, MD PA
Other - Org Name:PSYCHIATRIC MEDICINE AND COUNSELING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:MCJUNKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-324-7792
Mailing Address - Street 1:PO BOX 11647
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29731-1647
Mailing Address - Country:US
Mailing Address - Phone:803-324-7792
Mailing Address - Fax:803-981-7792
Practice Address - Street 1:200 OAKLAND AVE
Practice Address - Street 2:STE D
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730-4022
Practice Address - Country:US
Practice Address - Phone:803-324-7779
Practice Address - Fax:803-981-7792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1260101YP2500X
SC5558104100000X
SC2600106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC8086Medicare ID - Type UnspecifiedSC MEDICARE GROUP ID