Provider Demographics
NPI:1194979401
Name:THE CENTER FOR BEHAVIORAL MEDICINE
Entity type:Organization
Organization Name:THE CENTER FOR BEHAVIORAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:PAOLINI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:803-649-1866
Mailing Address - Street 1:1310 PINE LOG RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29803-7890
Mailing Address - Country:US
Mailing Address - Phone:803-649-1866
Mailing Address - Fax:803-649-1868
Practice Address - Street 1:1310 PINE LOG RD
Practice Address - Street 2:SUITE A
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-7890
Practice Address - Country:US
Practice Address - Phone:803-649-1866
Practice Address - Fax:803-649-1868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-13
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCDO 3412084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP0853Medicaid
E57021Medicare UPIN
SCGP0853Medicaid