| It's Your Move, Llc | |
|
208 Candi Ln Ste B Columbia SC 29210-8052 | |
| (877) 471-9865 | |
| (803) 335-5343 |
| Full Name | It's Your Move, Llc |
|---|---|
| Speciality | Counselor |
| Location | 208 Candi Ln Ste B, Columbia, South Carolina |
| Authorized Official Name and Position | Deeneka Lachelle Beach-phelps (CHEIF OPERATIONS OFFICER) |
| Authorized Official Contact | 2522170747 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| It's Your Move, Llc 425 Summit Terrace Ct Bldg 7b Columbia SC 29229-7055 Ph: (877) 471-9865 | It's Your Move, Llc 208 Candi Ln Ste B Columbia SC 29210-8052 Ph: (877) 471-9865 |
| NPI Number | 1396214987 |
|---|---|
| Provider Enumeration Date | 11/13/2018 |
| Last Update Date | 03/29/2024 |
| Certification Date | 03/29/2024 |
| Medicare PECOS PAC ID | 4880056837 |
|---|---|
| Medicare Enrollment ID | O20230808003840 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396214987 | NPI | - | NPPES |
| Provider Name | Willetta Rozena Jacobs |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033326590 PECOS PAC ID: 1254484611 Enrollment ID: I20190325002832 |
| Provider Name | Kenneth Leon Martin |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1093899007 PECOS PAC ID: 4183076789 Enrollment ID: I20240119000330 |
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