Provider Demographics
NPI:1033516067
Name:MENTAL HEALTH AMERICA OF SC
Entity Type:Organization
Organization Name:MENTAL HEALTH AMERICA OF SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AREA DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:H
Authorized Official - Last Name:ANAGNOS
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:843-974-4686
Mailing Address - Street 1:5060 DORCHESTER RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29418-5603
Mailing Address - Country:US
Mailing Address - Phone:843-974-4686
Mailing Address - Fax:843-974-4683
Practice Address - Street 1:5060 DORCHESTER RD
Practice Address - Street 2:SUITE 200
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29418-5603
Practice Address - Country:US
Practice Address - Phone:843-974-4686
Practice Address - Fax:843-974-4683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-19
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1043534191251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health