Provider Demographics
NPI:1417970393
Name:CAROLINA FORENSIC PSYCHIATRY LLC
Entity Type:Organization
Organization Name:CAROLINA FORENSIC PSYCHIATRY LLC
Other - Org Name:CAROLINA FORENSIC PSYCHIATRY LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:M
Authorized Official - Last Name:ALFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-980-2673
Mailing Address - Street 1:410 S HERLONG AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-8350
Mailing Address - Country:US
Mailing Address - Phone:803-980-2673
Mailing Address - Fax:803-980-2672
Practice Address - Street 1:410 S HERLONG AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-8350
Practice Address - Country:US
Practice Address - Phone:803-980-2673
Practice Address - Fax:803-980-2672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27609174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC8540Medicare PIN