| Phenomenal Paths Counseling Llc | |
|
636 Pine Ridge Dr Ste E West Columbia SC 29172-1867 | |
| (803) 830-2903 | |
| Not Available |
| Full Name | Phenomenal Paths Counseling Llc |
|---|---|
| Speciality | Social Worker |
| Location | 636 Pine Ridge Dr Ste E, West Columbia, South Carolina |
| Authorized Official Name and Position | Brittany Dorn (OWNER) |
| Authorized Official Contact | 8038302903 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Phenomenal Paths Counseling Llc 636 Pine Ridge Dr Ste E West Columbia SC 29172-1867 Ph: (180) 372-8559 | Phenomenal Paths Counseling Llc 636 Pine Ridge Dr Ste E West Columbia SC 29172-1867 Ph: (803) 830-2903 |
| NPI Number | 1932633062 |
|---|---|
| Provider Enumeration Date | 04/15/2017 |
| Last Update Date | 09/06/2023 |
| Certification Date | 09/01/2022 |
| Medicare PECOS PAC ID | 9133496029 |
|---|---|
| Medicare Enrollment ID | O20170524002583 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932633062 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 10133 (South Carolina) | Primary |
| Provider Name | Brittany T Dorn |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1891247730 PECOS PAC ID: 9537440102 Enrollment ID: I20161220001567 |
| Provider Name | Lauren L Pointer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1811481385 PECOS PAC ID: 3971852013 Enrollment ID: I20180822001579 |
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