| Envision Wellness Medical Group Llc | |
|
4100 N Main St Ste 101 Columbia SC 29203-5800 | |
| (803) 256-0101 | |
| (800) 854-3497 |
| Full Name | Envision Wellness Medical Group Llc |
|---|---|
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 4100 N Main St Ste 101, Columbia, South Carolina |
| Authorized Official Name and Position | Lisa Roberts (OFFICE MANAGER) |
| Authorized Official Contact | 8032560101 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Envision Wellness Medical Group Llc 4100 N Main St Ste 101 Columbia SC 29203-5800 Ph: (803) 256-0101 | Envision Wellness Medical Group Llc 4100 N Main St Ste 101 Columbia SC 29203-5800 Ph: (803) 256-0101 |
| NPI Number | 1710690912 |
|---|---|
| Provider Enumeration Date | 01/03/2023 |
| Last Update Date | 01/03/2023 |
| Certification Date | 01/03/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710690912 | NPI | - | NPPES |
| PC0151 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
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