Organization
ENVISION WELLNESS MEDICAL GROUP LLC
Active
Parent organization
ENVISION WELLNESS MEDICAL GROUP LLC
Other names
Envision Wellness Medical Group IOP
Organization subpart
Yes
Provider details
NPI number
Legal business name
ENVISION WELLNESS MEDICAL GROUP LLC
Authorized official
LISA ROBERTS (OFFICE MANAGER)
(803) 256-0101
Entity
Organization
Contact information
Practice address
4100 N MAIN ST STE 101, COLUMBIA, SC 29203-5800
(803) 256-0101
(800) 854-3497
Mailing address
4100 N MAIN ST STE 101, COLUMBIA, SC 29203-5800
(803) 256-0101
(800) 854-3497
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PC0151
—
SC
Enumeration date
01/03/2023
Last updated
01/03/2023
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