Provider Demographics
NPI:1659688091
Name:ACCESS COMMUNITY REHABILITATIVE BEHAVIORAL HEALTH SERVICES
Entity Type:Organization
Organization Name:ACCESS COMMUNITY REHABILITATIVE BEHAVIORAL HEALTH SERVICES
Other - Org Name:ACCESS COMMUNITY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEMBRALYN
Authorized Official - Middle Name:CURLEE
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPCI
Authorized Official - Phone:803-447-0001
Mailing Address - Street 1:106 FABRISTER LN
Mailing Address - Street 2:SUITE D
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-1911
Mailing Address - Country:US
Mailing Address - Phone:803-447-0001
Mailing Address - Fax:866-576-2589
Practice Address - Street 1:106 FABRISTER LN
Practice Address - Street 2:SUITE D
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-1911
Practice Address - Country:US
Practice Address - Phone:803-447-0001
Practice Address - Fax:866-576-2589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-07
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC119BHSMedicaid