Provider Demographics
NPI:1154329308
Name:CHESTER COUNTY COMMISION ON ALCOHOL AND DRUG ABUSE
Entity Type:Organization
Organization Name:CHESTER COUNTY COMMISION ON ALCOHOL AND DRUG ABUSE
Other - Org Name:THE HAZEL PITTMAN CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:T
Authorized Official - Last Name:BATES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-377-8111
Mailing Address - Street 1:130 HUDSON ST
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:SC
Mailing Address - Zip Code:29706-1524
Mailing Address - Country:US
Mailing Address - Phone:803-377-8111
Mailing Address - Fax:803-581-5380
Practice Address - Street 1:130 HUDSON ST
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:SC
Practice Address - Zip Code:29706-1524
Practice Address - Country:US
Practice Address - Phone:803-377-8111
Practice Address - Fax:803-581-5380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-12
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAD23CSMedicaid