| Maya Rake, Lisw-cp Llc | |
|
1415 Blanding St Ste 4 Columbia SC 29201-2922 | |
| (803) 779-7500 | |
| (803) 779-7522 |
| Full Name | Maya Rake, Lisw-cp Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1415 Blanding St Ste 4, Columbia, South Carolina |
| Authorized Official Name and Position | Maya Lynton Rake (OWNER) |
| Authorized Official Contact | 8036059956 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Maya Rake, Lisw-cp Llc 1415 Blanding St Ste 4 Columbia SC 29201-2922 Ph: (803) 779-7500 | Maya Rake, Lisw-cp Llc 1415 Blanding St Ste 4 Columbia SC 29201-2922 Ph: (803) 779-7500 |
| NPI Number | 1932737624 |
|---|---|
| Provider Enumeration Date | 03/30/2020 |
| Last Update Date | 10/03/2022 |
| Certification Date | 10/03/2022 |
| Medicare PECOS PAC ID | 8224468145 |
|---|---|
| Medicare Enrollment ID | O20200416003367 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932737624 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| Provider Name | Maya Lynton Rake |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1548626831 PECOS PAC ID: 4688004500 Enrollment ID: I20200416003483 |
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