1750501219 NPI number — COLUMBIA INSTITUTE FOR INDIVIDUAL, MARRIAGE AND FAMILY THERAPY

Table of content: (NPI 1750501219)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750501219 NPI number — COLUMBIA INSTITUTE FOR INDIVIDUAL, MARRIAGE AND FAMILY THERAPY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLUMBIA INSTITUTE FOR INDIVIDUAL, MARRIAGE AND FAMILY THERAPY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750501219
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/21/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4 LAKECREST DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29206-1371
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-606-1123
Provider Business Mailing Address Fax Number:
803-790-7496

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4 LAKECREST DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29206-1371
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-606-1123
Provider Business Practice Location Address Fax Number:
803-790-7496
Provider Enumeration Date:
04/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CARLSON
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
PAUL
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
803-606-1123

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  LPC # 22 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: $$$$$$$$$ . This is a "SOCIAL SECURITY NUMBER" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com