Provider Demographics
NPI:1972863496
Name:COLUMBIA AREA MENTAL HEALTH
Entity Type:Organization
Organization Name:COLUMBIA AREA MENTAL HEALTH
Other - Org Name:CARTER J STREET
Other - Org Type:Other Name
Authorized Official - Title/Position:LPN
Authorized Official - Prefix:MS
Authorized Official - First Name:SIVI
Authorized Official - Middle Name:BURNS
Authorized Official - Last Name:DANIELS
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:803-419-1526
Mailing Address - Street 1:1135 CARTER ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-2811
Mailing Address - Country:US
Mailing Address - Phone:806-786-1183
Mailing Address - Fax:803-754-6051
Practice Address - Street 1:1135 CARTER ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-2811
Practice Address - Country:US
Practice Address - Phone:806-786-1183
Practice Address - Fax:803-754-6051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-17
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCPR 38235320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness