# COLONIAL FAMILY PRACTICE, LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Parent organization:** COLONIAL FAMILY PRACTICE, LLC
- **Other names:** Colonial Behavioral Health
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1336810175
- **Legal business name:** COLONIAL FAMILY PRACTICE, LLC
- **Authorized official:** STEPHANIE KNIGHT DISHER (CREDENTIALING MANAGER)
- **Authorized official phone:** (803) 773-5227

## Contact information

- **Practice address:** 696 BULTMAN DR., SUMTER, SC 29150-2549
- **Practice address phone:** (803) 773-5227
- **Mailing address:** 674 W LIBERTY ST, SUMTER, SC 29150-4882
- **Mailing address phone:** (803) 773-5227
- **Mailing address fax:** (803) 757-4010

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101Y00000X | Counselor | — | NULL | — |
| 101Y00000X | Counselor | — | — | — |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | NULL | — |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | — | — |
| 101YM0800X | Mental Health Counselor | — | NULL | — |
| 101YM0800X | Mental Health Counselor | — | — | — |
| 101YP2500X | Professional Counselor | — | NULL | — |
| 101YP2500X | Professional Counselor | — | — | — |
| 2084P0804X | Child & Adolescent Psychiatry Physician | — | NULL | Yes |
| 2084P0804X | Child & Adolescent Psychiatry Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/22/2021
- **Last updated:** 09/22/2021