NPIMap

Organization Active NPI

Southeastern Success Center, LLC

  • Professional Counselor
  • Camden, SC
National Provider Identifier
1659800167
Registry record updated Oct 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
Legal business name
SOUTHEASTERN SUCCESS CENTER, LLC
Practice address
911 Lyttleton St
Camden, SC 29020-4412
Phone
(803) 713-7979
Fax
(803) 728-2200
NPI assigned
Jun 8, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2023

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

Authorized official

Name
Mary Myers Bridges, LPCNPI 1760808570
Title
Owner
Phone
(803) 713-7979

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X Primary

Addresses

Primary practice location

911 Lyttleton St
Camden, SC 29020-4412

Mailing address

PO Box 2487
Camden, SC 29020-8009
Phone (803) 729-5161

Other practice location 1

3612 Landmark Dr Ste B
Columbia, SC 29204-4039
Phone (803) 779-3548

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240402003111 SC Part B Supplier - Clinic/Group Practice 6608214242 Receives reassigned benefits from 2 practitioners
Practice locations: Camden, SC

National Provider Directory

National Provider Directory

Locations

911 Lyttleton St
Camden, SC 29020
Phone (803) 713-7979

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1496880000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696550400000",
    "number": "1659800167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2487",
            "city": "CAMDEN",
            "state": "SC",
            "postal_code": "290208009",
            "telephone_number": "803-729-5161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "911 LYTTLETON ST",
            "city": "CAMDEN",
            "state": "SC",
            "postal_code": "290204412",
            "telephone_number": "803-713-7979",
            "fax_number": "803-728-2200"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3612 Landmark Dr Ste B",
            "address_purpose": "LOCATION",
            "city": "Columbia",
            "state": "SC",
            "postal_code": "292044039",
            "country_code": "US",
            "telephone_number": "803-779-3548",
            "fax_number": "803-779-7055",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SOUTHEASTERN SUCCESS CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-08",
        "last_updated": "2023-10-06",
        "certification_date": "2023-10-06",
        "status": "A",
        "authorized_official_last_name": "BRIDGES",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "MYERS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "803-713-7979",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Camden, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.