Organization
BRIDGES CLUBHOUSE MENTAL HEALTH OF AMERICA SOUTH CAROLINA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS KELLY ANN TUCKER M.R.C. (CLINICAL COUNSELOR)
(803) 796-0353
Entity
Organization
Contact information
Practice address
2105 COMMERCE DR, CAYCE, SC 29033-1524
(803) 796-6179
Mailing address
2021 ELM ABODE TER, COLUMBIA, SC 29210-7724
(803) 446-4246
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
01858 600
SC
Other
Enumeration date
05/30/2007
Last updated
08/07/2007
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