Provider Demographics
NPI:1427392026
Name:JUSTICE WORKS BEHAVIORAL CARE
Entity Type:Organization
Organization Name:JUSTICE WORKS BEHAVIORAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:CHRISTIAN
Authorized Official - Suffix:
Authorized Official - Credentials:M ED
Authorized Official - Phone:843-488-1615
Mailing Address - Street 1:200 ELM ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-5118
Mailing Address - Country:US
Mailing Address - Phone:843-359-7538
Mailing Address - Fax:843-488-1616
Practice Address - Street 1:200 ELM ST
Practice Address - Street 2:SUITE 1
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-5118
Practice Address - Country:US
Practice Address - Phone:843-359-7538
Practice Address - Fax:843-488-1616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
SCDO NOT HAVE ONE251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty