Provider Demographics
NPI:1255712964
Name:SC DEPARTMENT OF MENTAL HEALTH
Entity type:Organization
Organization Name:SC DEPARTMENT OF MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HUMAN SERVICES COORDINATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:803-327-2012
Mailing Address - Street 1:166 DOTSON ST
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-2334
Mailing Address - Country:US
Mailing Address - Phone:843-801-1624
Mailing Address - Fax:
Practice Address - Street 1:166 DOTSON ST
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-2334
Practice Address - Country:US
Practice Address - Phone:803-327-2012
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-18
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management