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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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