Organization Name: | MHA |
NPI Number: | 1285962886 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | CARLISSA Y GOODWIN (CARE PROVIDER) |
Mailing Address: | 200 Claude Bundrick Rd Blythewood |
State: | SC US |
Postal Code: | 290169420 |
Phone Number: | 8037865478 |
Fax Number: | |
NPI Enumeration Date: | 11/20/2009 |
NPI Last Update Date: | 11/20/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 101YM0800X |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | SC |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |