Provider Demographics
NPI:1689018400
Name:PEE DEE MENTAL HEALTH
Entity Type:Organization
Organization Name:PEE DEE MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HUMAN SERVICES COORDINATOR I
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:D
Authorized Official - Last Name:GAMBLE
Authorized Official - Suffix:
Authorized Official - Credentials:MHP
Authorized Official - Phone:843-639-8042
Mailing Address - Street 1:900 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:HARTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29550-5787
Mailing Address - Country:US
Mailing Address - Phone:843-639-8042
Mailing Address - Fax:
Practice Address - Street 1:900 S 4TH ST
Practice Address - Street 2:
Practice Address - City:HARTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29550-5787
Practice Address - Country:US
Practice Address - Phone:843-639-8045
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-23
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health