Basic Information
| Provider Information | |||||||||
| NPI: | 1982975439 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ONEDAYMAMA LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3430 LYLES ST | ||||||||
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| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292011323 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 125 ALPINE CIR | ||||||||
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| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292236385 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8037793548 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/14/2012 | ||||||||
| LastUpdateDate: | 01/14/2012 | ||||||||
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| AuthorizedOfficialLastName: | DUKES | ||||||||
| AuthorizedOfficialFirstName: | ELIZABETH | ||||||||
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| AuthorizedOfficialTitleorPosition: | MENTAL HEALTH THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 8033125999 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LPC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 5266 | SC | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.