Organization
PIECES 2 PEACE WELLNESS CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ANNA B. GANTT-GORDON LPC (CO-OWNER)
(803) 250-5198
Entity
Organization
Contact information
Practice address
1105 BELLEVIEW ST STE 103, COLUMBIA, SC 29201-1839
(803) 250-5198
Mailing address
PO BOX 9054, COLUMBIA, SC 29290-0054
(803) 250-5198
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PC2197
—
SC
01
—
QMP000005514755
MOLINA HEALTHCARE
SC
Enumeration date
10/01/2020
Last updated
10/01/2020
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