Provider Demographics
NPI:1518979202
Name:GEORGETOWN COUNTY ALCOHOL & DRUG ABUSE COMMISSION
Entity Type:Organization
Organization Name:GEORGETOWN COUNTY ALCOHOL & DRUG ABUSE COMMISSION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RALPHAEL
Authorized Official - Middle Name:MENSAH
Authorized Official - Last Name:CARR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-546-6081
Mailing Address - Street 1:PO BOX 515
Mailing Address - Street 2:1
Mailing Address - City:GEORGETOWN
Mailing Address - State:SC
Mailing Address - Zip Code:29442-0515
Mailing Address - Country:US
Mailing Address - Phone:843-546-6081
Mailing Address - Fax:843-527-1697
Practice Address - Street 1:1423 WINYAH ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:SC
Practice Address - Zip Code:29440-4730
Practice Address - Country:US
Practice Address - Phone:843-546-6081
Practice Address - Fax:843-527-1697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCADO5GTMedicaid