Provider Demographics
NPI:1437701364
Name:COLUMBIA PSYCHOLOGICAL SERVICES
Entity type:Organization
Organization Name:COLUMBIA PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:BAGNELL
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:803-250-5109
Mailing Address - Street 1:6024 ROBINWOOD RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29206-4358
Mailing Address - Country:US
Mailing Address - Phone:803-250-5109
Mailing Address - Fax:
Practice Address - Street 1:1331 ELMWOOD AVE STE 300B
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2150
Practice Address - Country:US
Practice Address - Phone:803-250-5109
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-11
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty