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1601 Assembly St Columbia SC 29202-4501 | |
| (910) 912-3367 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1601 Assembly St, Columbia, South Carolina |
| Authorized Official Name and Position | L. Demetress Long, (PRESIDENT, OWNER) |
| Authorized Official Contact | 9109123367 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1601 Assembly Street, Gd Columbia SC 29202 Ph: (910) 912-3367 | 1601 Assembly St Columbia SC 29202-4501 Ph: (910) 912-3367 |
| NPI Number | 1861217903 |
|---|---|
| Provider Enumeration Date | 11/22/2024 |
| Last Update Date | 12/08/2024 |
| Certification Date | 12/07/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861217903 | NPI | - | NPPES |
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