Individual provider Active NPI

Mitchell Culbertson, MBA, MS, LPC, NCC

  • Professional Counselor
  • Columbia, SC
National Provider Identifier
1215408711
Registry record updated Dec 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
7655 Issued in SC
Practice address
3031 Scotsman Rd Ste 20
Columbia, SC 29223-1812
Phone
(803) 834-8272
NPI assigned
Dec 9, 2018
Last updated
Dec 1, 2020By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 1, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 7655 SC Primary

Addresses

Primary practice location

3031 Scotsman Rd Ste 20
Columbia, SC 29223-1812

Mailing address

306 Bowhunter Dr
Blythewood, SC 29016-9204
Phone (803) 754-3892

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240514002133 SC Practitioner - Mental Health Counselor 2264843051 Practice locations: Columbia, SC

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2017
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

3031 Scotsman Rd
Suite 20
Columbia, SC 29223-1812
Phone (803) 834-8272

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Business Administration, Master of Science

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1544313600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606780800000",
    "number": "1215408711",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "306 BOWHUNTER DR",
            "city": "BLYTHEWOOD",
            "state": "SC",
            "postal_code": "290169204",
            "telephone_number": "803-754-3892"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3031 SCOTSMAN RD STE 20",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292231812",
            "telephone_number": "803-834-8272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CULBERTSON",
        "first_name": "MITCHELL",
        "credential": "MBA, MS, LPC, NCC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-12-09",
        "last_updated": "2020-12-01",
        "certification_date": "2020-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "SC",
            "license": "7655",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, SC

Sources for this page

Verify at the official NPI Registry.