Provider Demographics
NPI:1780865378
Name:MILITARY SPOUSAL SUPPORT CENTER
Entity Type:Organization
Organization Name:MILITARY SPOUSAL SUPPORT CENTER
Other - Org Name:MSSC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:KING
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-324-1976
Mailing Address - Street 1:410 OAKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29730-3530
Mailing Address - Country:US
Mailing Address - Phone:803-324-1976
Mailing Address - Fax:803-324-4578
Practice Address - Street 1:410 OAKLAND AVE
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730-3530
Practice Address - Country:US
Practice Address - Phone:803-324-1976
Practice Address - Fax:803-324-4578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-24
Last Update Date:2007-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCCSM1561251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC3645P0809XOtherPSYCH CNS