NPIMap

Organization Active NPI

Play Therapy With Carmen

  • Clinical Social Worker
  • Columbia, SC
National Provider Identifier
1679009559
Registry record updated May 11, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
10478 Issued in SC
Legal business name
PLAY THERAPY WITH CARMEN
Practice address
300 Berkshire Dr Ste F
Columbia, SC 29223-1859
Phone
(980) 275-2505
NPI assigned
May 11, 2017
Organization subpart
Yes
Parent organization
OUTSPOKEN COUNSELING AND CONSULTING LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 11, 2017

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

Authorized official

Name
Carmen Jimenez, LISW, LCSW, RPTS
Title
Founder
Phone
(980) 275-2505

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X 10478 SC Primary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X C008505 SC
Community/Behavioral Health Agency 251S00000X

Addresses

Primary practice location

300 Berkshire Dr Ste F
Columbia, SC 29223-1859

Mailing address

PO Box 8804
Columbia, SC 29202-8804
Phone (980) 275-2505

Other names 1

  • Carmen JImenez Doing business as

National Provider Directory

National Provider Directory

Locations

300 Berkshire Dr
Ste F
Columbia, SC 29223
Phone (980) 215-2505

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 2

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": "1494460800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1494460800000",
    "number": "1679009559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8804",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292028804",
            "telephone_number": "980-275-2505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 BERKSHIRE DR STE F",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292231859",
            "telephone_number": "980-275-2505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PLAY THERAPY WITH CARMEN",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "OUTSPOKEN COUNSELING AND CONSULTING LLC",
        "enumeration_date": "2017-05-11",
        "last_updated": "2017-05-11",
        "status": "A",
        "authorized_official_last_name": "JIMENEZ",
        "authorized_official_first_name": "CARMEN",
        "authorized_official_title_or_position": "FOUNDER",
        "authorized_official_telephone_number": "980-275-2505",
        "authorized_official_credential": "LISW, LCSW, RPTS"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "SC",
            "license": "10478",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "SC",
            "license": "C008505",
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Carmen JImenez",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Columbia, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2017; 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.