Provider Demographics
NPI:1215243803
Name:BROTHER2BROTHER
Entity type:Organization
Organization Name:BROTHER2BROTHER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:M
Authorized Official - Last Name:COLES
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:803-699-1050
Mailing Address - Street 1:3031 SCOTSMAN RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-1812
Mailing Address - Country:US
Mailing Address - Phone:803-699-1050
Mailing Address - Fax:803-699-1067
Practice Address - Street 1:3031 SCOTSMAN RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-1812
Practice Address - Country:US
Practice Address - Phone:803-699-1050
Practice Address - Fax:803-699-1067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-20
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health