Provider Demographics
NPI:1114922283
Name:FLORENCE COUNTY COMMISSION ON ALCOHOL AND DRU
Entity Type:Organization
Organization Name:FLORENCE COUNTY COMMISSION ON ALCOHOL AND DRU
Other - Org Name:CIRCLE PARK BEHAVIORAL HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DEPUTY CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:TERRELL
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:843-665-9349
Mailing Address - Street 1:PO BOX 6196
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29502
Mailing Address - Country:US
Mailing Address - Phone:843-665-3929
Mailing Address - Fax:843-667-1615
Practice Address - Street 1:601 GREG AVENUE
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501
Practice Address - Country:US
Practice Address - Phone:843-665-3928
Practice Address - Fax:843-667-1615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-16
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAD04FLMedicaid