Provider Demographics
NPI:1487269585
Name:CONCRETE CLINICAL SOLUTIONS
Entity type:Organization
Organization Name:CONCRETE CLINICAL SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHAMIQUIA
Authorized Official - Middle Name:NIKIA
Authorized Official - Last Name:MCPHERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPCS
Authorized Official - Phone:803-881-5599
Mailing Address - Street 1:PO BOX 50579
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-0579
Mailing Address - Country:US
Mailing Address - Phone:803-881-5599
Mailing Address - Fax:
Practice Address - Street 1:1627 AUBURN ST.
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204
Practice Address - Country:US
Practice Address - Phone:803-881-5599
Practice Address - Fax:803-724-6758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNONEMedicaid