Provider Demographics
NPI:1851476337
Name:DORCHESTER COMMISSION ON ALCOHOL AND DRUG ABUSE
Entity Type:Organization
Organization Name:DORCHESTER COMMISSION ON ALCOHOL AND DRUG ABUSE
Other - Org Name:DORCHESTER ALCOHOL AND DRUG COMMISSION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:MALPHRUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-871-4790
Mailing Address - Street 1:320 MIDLAND PKWY STE C
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-7195
Mailing Address - Country:US
Mailing Address - Phone:843-871-4790
Mailing Address - Fax:844-965-9336
Practice Address - Street 1:320 MIDLAND PKWY STE C
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-7195
Practice Address - Country:US
Practice Address - Phone:843-871-4790
Practice Address - Fax:844-965-9336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCOTP-015101YA0400X, 101YM0800X
SC261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAD16DOMedicaid
SCQ323864416Medicare ID - Type Unspecified
SCQ311444416Medicare ID - Type Unspecified
SCQ319804416Medicare ID - Type Unspecified
SCAD16DOMedicaid