Provider Demographics
NPI:1245435023
Name:ASCENSION BEHAVIORAL HEALTHCARE, P.A.
Entity type:Organization
Organization Name:ASCENSION BEHAVIORAL HEALTHCARE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:LEE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:803-329-1915
Mailing Address - Street 1:452 LAKESHORE PKWY
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29730-4291
Mailing Address - Country:US
Mailing Address - Phone:803-329-1915
Mailing Address - Fax:
Practice Address - Street 1:452 LAKESHORE PKWY
Practice Address - Street 2:SUITE 105
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730-4291
Practice Address - Country:US
Practice Address - Phone:803-329-1915
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC258232084F0202X, 2084P0800X
LA2009142084F0202X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic PsychiatryGroup - Multi-Specialty
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC258232Medicaid