Provider Demographics
NPI:1720154107
Name:LOW COUNTRY OUTREACH SERVICES
Entity Type:Organization
Organization Name:LOW COUNTRY OUTREACH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DANITA
Authorized Official - Middle Name:ROSSER
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-546-0526
Mailing Address - Street 1:7001 SAINT ANDREWS RD
Mailing Address - Street 2:STE 319
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29212-1137
Mailing Address - Country:US
Mailing Address - Phone:803-546-0526
Mailing Address - Fax:
Practice Address - Street 1:425 S WHEELER AVE
Practice Address - Street 2:
Practice Address - City:PROSPERITY
Practice Address - State:SC
Practice Address - Zip Code:29127-9347
Practice Address - Country:US
Practice Address - Phone:803-546-0526
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty