Provider Demographics
NPI:1710972120
Name:AIKEN COUNTY COMMISSION ON ALCOHOL AND DRUG ABUSE
Entity Type:Organization
Organization Name:AIKEN COUNTY COMMISSION ON ALCOHOL AND DRUG ABUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HERB
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTOCKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-649-1900
Mailing Address - Street 1:1105 GREGG HWY
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29801-6341
Mailing Address - Country:US
Mailing Address - Phone:803-649-1900
Mailing Address - Fax:803-643-2926
Practice Address - Street 1:1105 GREGG HWY
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-6341
Practice Address - Country:US
Practice Address - Phone:803-649-1900
Practice Address - Fax:803-643-2926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-13
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCOTP006251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAD01AKMedicaid
=========Other3RD PARTY PAYERS