Provider Demographics
NPI:1861838054
Name:DISABILITY AND AUTISM SERVICES OF SOUTH CAROLINA
Entity Type:Organization
Organization Name:DISABILITY AND AUTISM SERVICES OF SOUTH CAROLINA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-240-7001
Mailing Address - Street 1:83 OLDE CANAL LOOP
Mailing Address - Street 2:
Mailing Address - City:PAWLEYS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29585-7847
Mailing Address - Country:US
Mailing Address - Phone:843-240-7001
Mailing Address - Fax:843-235-0450
Practice Address - Street 1:83 OLDE CANAL LOOP
Practice Address - Street 2:
Practice Address - City:PAWLEYS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29585-7847
Practice Address - Country:US
Practice Address - Phone:843-240-7001
Practice Address - Fax:843-235-0450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-15
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1-04-1487103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty