Provider Demographics
NPI:1043360670
Name:FLORENCE CRITTENTON PROGRAMS OF SOUTH CAROLINA
Entity Type:Organization
Organization Name:FLORENCE CRITTENTON PROGRAMS OF SOUTH CAROLINA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:L
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:LISW-CP
Authorized Official - Phone:843-722-7526
Mailing Address - Street 1:19 SAINT MARGARET ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29403-3612
Mailing Address - Country:US
Mailing Address - Phone:843-722-7526
Mailing Address - Fax:843-577-0770
Practice Address - Street 1:19 SAINT MARGARET ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29403-3612
Practice Address - Country:US
Practice Address - Phone:843-722-7526
Practice Address - Fax:843-577-0770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCMC0066Medicaid