Provider Demographics
NPI:1942530233
Name:MENTAL HEALTH AMERICA
Entity Type:Organization
Organization Name:MENTAL HEALTH AMERICA
Other - Org Name:KIVA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:AMINSTRATIVE ASSIST
Authorized Official - Phone:803-754-5478
Mailing Address - Street 1:117 WOODLANDS VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIAS
Mailing Address - State:SC
Mailing Address - Zip Code:29229
Mailing Address - Country:US
Mailing Address - Phone:803-261-9320
Mailing Address - Fax:
Practice Address - Street 1:200 CLAUDE BUNDRICK RD
Practice Address - Street 2:
Practice Address - City:BLYTHEWOOD
Practice Address - State:SC
Practice Address - Zip Code:29016
Practice Address - Country:US
Practice Address - Phone:803-754-5478
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MHA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-01-08
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC320800000X320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness