Provider Demographics
NPI:1750501219
Name:COLUMBIA INSTITUTE FOR INDIVIDUAL, MARRIAGE AND FAMILY THERAPY
Entity Type:Organization
Organization Name:COLUMBIA INSTITUTE FOR INDIVIDUAL, MARRIAGE AND FAMILY THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:MDIV,THD
Authorized Official - Phone:803-606-1123
Mailing Address - Street 1:4 LAKECREST DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29206-1371
Mailing Address - Country:US
Mailing Address - Phone:803-606-1123
Mailing Address - Fax:803-790-7496
Practice Address - Street 1:4 LAKECREST DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29206-1371
Practice Address - Country:US
Practice Address - Phone:803-606-1123
Practice Address - Fax:803-790-7496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLPC # 22251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
$$$$$$$$$OtherSOCIAL SECURITY NUMBER