Organization
EMINENCE IMAGE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LATASHA MICHELLE BETHEA (OWNER)
(910) 853-2184
Entity
Organization
Contact information
Practice address
1407 ELMWOOD AVE, COLUMBIA, SC 29201-2109
(910) 853-2184
Mailing address
1407 ELMWOOD AVE, COLUMBIA, SC 29201-2109
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
101YP2500X
Professional Counselor
—
—
251S00000X
Community/Behavioral Health Agency
—
—
Other
Enumeration date
08/28/2016
Last updated
08/28/2016
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