Provider Demographics
NPI:1013375534
Name:GOOD DEEDS CASE MANAGEMENT SERVICES LLC
Entity Type:Organization
Organization Name:GOOD DEEDS CASE MANAGEMENT SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TIRIEKA
Authorized Official - Middle Name:BROWN
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, SSP, MHP
Authorized Official - Phone:843-697-4587
Mailing Address - Street 1:1324 SECESSIONVILLE RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-8231
Mailing Address - Country:US
Mailing Address - Phone:843-697-4587
Mailing Address - Fax:
Practice Address - Street 1:1324 SECESSIONVILLE RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-8231
Practice Address - Country:US
Practice Address - Phone:843-697-4587
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-29
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4674103TS0200X
251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase Management
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCEX1518Medicaid