Provider Demographics
NPI:1255703575
Name:OPTIONS FOR SOCIAL CHANGE, LLC
Entity type:Organization
Organization Name:OPTIONS FOR SOCIAL CHANGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LISW CP/AP
Authorized Official - Phone:843-343-4188
Mailing Address - Street 1:2396 ERSKINE AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-7004
Mailing Address - Country:US
Mailing Address - Phone:843-343-4188
Mailing Address - Fax:
Practice Address - Street 1:2145 DORCHESTER RD
Practice Address - Street 2:
Practice Address - City:N CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405-7763
Practice Address - Country:US
Practice Address - Phone:843-343-4188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-26
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC 1449251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCK2T2J72GD2FM0DBMedicaid