Provider Demographics
NPI:1255525648
Name:CAROLINA YOUTH COMBAT SYSTEMS
Entity type:Organization
Organization Name:CAROLINA YOUTH COMBAT SYSTEMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ADELL
Authorized Official - Middle Name:A
Authorized Official - Last Name:DOBEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-480-4051
Mailing Address - Street 1:133 NICHOLSON RD
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:SC
Mailing Address - Zip Code:29847-2629
Mailing Address - Country:US
Mailing Address - Phone:803-480-4051
Mailing Address - Fax:
Practice Address - Street 1:722 AUGUSTA RD
Practice Address - Street 2:
Practice Address - City:EDGEFIELD
Practice Address - State:SC
Practice Address - Zip Code:29824
Practice Address - Country:US
Practice Address - Phone:803-637-5526
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty