Provider Demographics
NPI:1144569872
Name:SCDJJ
Entity Type:Organization
Organization Name:SCDJJ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:DEMORRIE
Authorized Official - Middle Name:LASHAUN
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:803-896-4753
Mailing Address - Street 1:5000 BROAD RIVER RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29212-3532
Mailing Address - Country:US
Mailing Address - Phone:803-896-4753
Mailing Address - Fax:
Practice Address - Street 1:5000 BROAD RIVER RD
Practice Address - Street 2:GOLF UNIT/BIRCHWOOD CAMPUS
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29212-3532
Practice Address - Country:US
Practice Address - Phone:803-896-4753
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-31
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8850251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health