42D2119173 CLIA NUMBER - MENTAL ILLNESS PRIMARY RECOVERY CENTER, INC

Laboratory Demographics

  • CLIA Code: 42D2119173
  • Facility Name: MENTAL ILLNESS PRIMARY RECOVERY CENTER, INC
  • Facility Address: 2750 LAUREL STREET SUITE 303
    COLUMBIA, SC
    ZIP 29204
  • Facility Phone: 803 786-1844
  • Facility Type: Community Clinic
  • Facility Type: Waiver
  • Lab Director: LESLIE ALDERMAN
  • NPI Number: 1194047563
  • Taxonomy: 251S00000X - Community/Behavioral Health

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CLIA Record

Field Name Field Value
CLIA Number 42D2119173
LAB Type Community Clinic
Facility Name MENTAL ILLNESS PRIMARY RECOVERY CENTER, INC
Street 2750 LAUREL STREET SUITE 303
City COLUMBIA
State SC
ZIP 29204
Phone 803 786-1844
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/21/2024
Certificate Expiration Date 9/20/2026
Facility Type Community Clinic
Lab Director LESLIE ALDERMAN

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This page was last updated on: 9/29/2025