| Mha | |
|
200 Claude Bundrick Rd Blythewood SC 29016-9420 | |
| (803) 786-5478 | |
| Not Available |
| Full Name | Mha |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 200 Claude Bundrick Rd, Blythewood, South Carolina |
| Authorized Official Name and Position | Carlissa Y Goodwin (CARE PROVIDER) |
| Authorized Official Contact | 8037359680 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mha 419 Torwood Dr Columbia SC 29203 Ph: (803) 714-0948 | Mha 200 Claude Bundrick Rd Blythewood SC 29016-9420 Ph: (803) 786-5478 |
| NPI Number | 1285962886 |
|---|---|
| Provider Enumeration Date | 11/20/2009 |
| Last Update Date | 11/20/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285962886 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 101YM0800X (South Carolina) | Primary |
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