Organization
COLONIAL FAMILY PRACTICE, LLC
Active
Parent organization
COLONIAL FAMILY PRACTICE, LLC
Other names
Colonial Behavioral Health
Organization subpart
Yes
Provider details
NPI number
Legal business name
COLONIAL FAMILY PRACTICE, LLC
Authorized official
STEPHANIE KNIGHT DISHER (CREDENTIALING MANAGER)
(803) 773-5227
Entity
Organization
Contact information
Practice address
696 BULTMAN DR., SUMTER, SC 29150-2549
(803) 773-5227
Mailing address
674 W LIBERTY ST, SUMTER, SC 29150-4882
(803) 773-5227
(803) 757-4010
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
—
—
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
—
—
Other
Enumeration date
09/22/2021
Last updated
09/22/2021
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