Organization
MULTIDISCIPLINARY THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TORI SULLIVAN LEATHERS M.A., CCC-SLP (PRESIDENT, CEO)
(803) 410-5483
Entity
Organization
Contact information
Practice address
1612 MARION ST STE 218G, COLUMBIA, SC 29201-2939
(803) 410-5483
(803) 250-2651
Mailing address
1634 TAYLOR ST, COLUMBIA, SC 29201-3451
(803) 410-5483
(803) 250-2651
Taxonomy
Speciality
Code
Description
License number
State
221700000X
Art Therapist
—
—
225100000X
Physical Therapist
—
—
225A00000X
Music Therapist
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP8479
—
SC
Enumeration date
07/12/2018
Last updated
10/31/2023
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