Provider Demographics
NPI:1093258444
Name:CAROLINA BEHAVIORAL HEALTH SERVICES
Entity Type:Organization
Organization Name:CAROLINA BEHAVIORAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHEAL
Authorized Official - Middle Name:GEROD
Authorized Official - Last Name:GORE
Authorized Official - Suffix:
Authorized Official - Credentials:MSSA, LISW-CP
Authorized Official - Phone:803-467-1263
Mailing Address - Street 1:130 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-4237
Mailing Address - Country:US
Mailing Address - Phone:803-774-4377
Mailing Address - Fax:803-774-4378
Practice Address - Street 1:130 BROAD ST
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-4237
Practice Address - Country:US
Practice Address - Phone:803-774-4377
Practice Address - Fax:803-774-4378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-01
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health