| Corazon Of South Carolina, Llc | |
|
1631 Main St Fl 2 Columbia SC 29201-2817 | |
| (803) 567-1217 | |
| Not Available |
| Full Name | Corazon Of South Carolina, Llc |
|---|---|
| Speciality | Clinic/center - Adolescent And Children Mental Health |
| Location | 1631 Main St Fl 2, Columbia, South Carolina |
| Authorized Official Name and Position | Kimberly Kocak (OWNER) |
| Authorized Official Contact | 6145515760 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Corazon Of South Carolina, Llc 1631 Main St Fl 2 Columbia SC 29201-2817 Ph: (803) 567-1217 | Corazon Of South Carolina, Llc 1631 Main St Fl 2 Columbia SC 29201-2817 Ph: (803) 567-1217 |
| NPI Number | 1326715541 |
|---|---|
| Provider Enumeration Date | 08/25/2021 |
| Last Update Date | 08/25/2021 |
| Certification Date | 08/25/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326715541 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Secondary |
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