| Cofa, Llc | |
|
106 E Thomas St Lake City SC 29560-2639 | |
| (843) 229-8504 | |
| (843) 374-2632 |
| Full Name | Cofa, Llc |
|---|---|
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 106 E Thomas St, Lake City, South Carolina |
| Authorized Official Name and Position | Kelvin Williams (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 8432298504 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Cofa, Llc 106 East Thomas Street Po Box 394 Lake City SC 29560 Ph: () - | Cofa, Llc 106 E Thomas St Lake City SC 29560-2639 Ph: (843) 229-8504 |
| NPI Number | 1639384761 |
|---|---|
| Provider Enumeration Date | 05/11/2007 |
| Last Update Date | 01/17/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639384761 | NPI | - | NPPES |
| GP3880 | Medicaid | SC | |
| GP4013 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 55 (South Carolina) | Secondary |
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 213469 (South Carolina) | Primary |
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