Provider Demographics
NPI:1154183499
Name:PARAGON WELLNESS
Entity type:Organization
Organization Name:PARAGON WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL DIRECTOR/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JOSETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUMTER-COBB
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-S
Authorized Official - Phone:803-413-5586
Mailing Address - Street 1:7 CONIFER CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-9569
Mailing Address - Country:US
Mailing Address - Phone:803-413-5586
Mailing Address - Fax:
Practice Address - Street 1:7 CONIFER CT
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-9569
Practice Address - Country:US
Practice Address - Phone:803-413-5586
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-23
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health