| NPI | 1194213918 |
|---|---|
| Doing Business As | MATRIX BEHAVIORAL HEALTH PRACTICE LLC |
| Entity Type | Organization |
| Authorized Contact | BRENDA LEONA RIDGEWAY CEO/Clinical Practitioner 803-260-9897 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: KS 525) |
| Additional Taxonomies | 103TA0400X Psychologist Addiction (Substance Use Disorder) |
| Enumeration Date | 2018-04-26 |
| Last Update Date | 2021-07-08 |