NPIMap

Organization Active NPI

Sankofa Therapeutic Concepts, LLC

  • Clinical Social Worker
  • Fort Mill, SC
National Provider Identifier
1588816870
Registry record updated Jun 1, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
C005480 Issued in NC
Legal business name
SANKOFA THERAPEUTIC CONCEPTS, LLC
Practice address
130 Ben Casey Dr
Ste 102
Fort Mill, SC 29708-6567
Phone
(803) 386-3064
Fax
(866) 591-1741
NPI assigned
Oct 17, 2008
Last updated
Jun 1, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2011

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

Authorized official

Name
Ms. Donita P Holmes, LISW-CPNPI 1295778728
Title
Owner/Clinical Consultant
Phone
(803) 207-0993

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X F0704137 NC
Psychiatric/Mental Health Clinical Nurse Specialist 364SP0808X 4345 SC
Clinical Social Worker 1041C0700X 8780 SC
Clinical Social Worker 1041C0700X C005480 NC Primary

Addresses

Primary practice location

130 Ben Casey Dr
Ste 102
Fort Mill, SC 29708-6567

Mailing address

2879 Highway 160 W
PMB 4408
Fort Mill, SC 29708-8581
Phone (803) 386-3064

Other identifiers 1

IdentifierTypeStateIssuer
6006793MedicaidNC

Other names 1

  • Sankofa Therapeutic Concepts, PLLC Other name

National Provider Directory

National Provider Directory

Locations

130 Ben Casey Dr
Ste 102
Fort Mill, SC 29708
Phone (803) 378-2895

2879 Highway 160 W
Fort Mill, SC 29708

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1224201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1306886400000",
    "number": "1588816870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2879 HIGHWAY 160 W",
            "address_2": "PMB 4408",
            "city": "FORT MILL",
            "state": "SC",
            "postal_code": "297088581",
            "telephone_number": "803-386-3064",
            "fax_number": "866-591-1741"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 BEN CASEY DR",
            "address_2": "STE 102",
            "city": "FORT MILL",
            "state": "SC",
            "postal_code": "297086567",
            "telephone_number": "803-386-3064",
            "fax_number": "866-591-1741"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANKOFA THERAPEUTIC CONCEPTS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-17",
        "last_updated": "2011-06-01",
        "status": "A",
        "authorized_official_last_name": "HOLMES",
        "authorized_official_first_name": "DONITA",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "OWNER/CLINICAL CONSULTANT",
        "authorized_official_telephone_number": "803-207-0993",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LISW-CP"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NC",
            "license": "F0704137",
            "primary": false
        },
        {
            "code": "364SP0808X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Psychiatric/Mental Health",
            "state": "SC",
            "license": "4345",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "SC",
            "license": "8780",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C005480",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6006793",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sankofa Therapeutic Concepts, PLLC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Fort Mill, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.