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Organization

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Active
Organization subpart
No

Provider details

NPI number
Authorized official
DEENEKA LACHELLE BEACH-PHELPS (CEO)
(877) 471-9865
Entity
Organization

Contact information

Practice address
425 SUMMIT TERRACE CT STE 7B, COLUMBIA, SC 29229-7055
(877) 471-9865
(803) 335-5343
Mailing address
425 SUMMIT TERRACE CT STE 7B, COLUMBIA, SC 29229-7055
(877) 471-9865
(803) 335-5343

Taxonomy

Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
GP8718
SC
Enumeration date
01/26/2022
Last updated
01/26/2022
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