Provider Demographics
NPI:1205175452
Name:S.C DEPARTMENT OF JUVENILE JUSTICE
Entity type:Organization
Organization Name:S.C DEPARTMENT OF JUVENILE JUSTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF SOCIAL WORK
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GIESEN
Authorized Official - Suffix:
Authorized Official - Credentials:LIMSW
Authorized Official - Phone:803-896-4813
Mailing Address - Street 1:2112 CHANDLER AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-6204
Mailing Address - Country:US
Mailing Address - Phone:803-896-9784
Mailing Address - Fax:
Practice Address - Street 1:2112 CHANDLER AVE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-6204
Practice Address - Country:US
Practice Address - Phone:803-896-9784
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-07
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3627322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children