Provider Demographics
NPI:1134127475
Name:PICKENS COUNTY COMMISSION ON ALCOHOL & DRUG ABUSE
Entity Type:Organization
Organization Name:PICKENS COUNTY COMMISSION ON ALCOHOL & DRUG ABUSE
Other - Org Name:BEHAVIORAL HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, FINANCIAL & ADMINISTRATIV
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:A
Authorized Official - Last Name:ELLENBURG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-898-5800
Mailing Address - Street 1:309 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PICKENS
Mailing Address - State:SC
Mailing Address - Zip Code:29671-2319
Mailing Address - Country:US
Mailing Address - Phone:864-898-5800
Mailing Address - Fax:864-898-5804
Practice Address - Street 1:309 E MAIN ST
Practice Address - Street 2:
Practice Address - City:PICKENS
Practice Address - State:SC
Practice Address - Zip Code:29671-2319
Practice Address - Country:US
Practice Address - Phone:864-898-5800
Practice Address - Fax:864-898-5804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-11
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAD36PKMedicaid