Provider Demographics
NPI:1740340801
Name:TRINITY BEHAVIORAL CARE DILLON OFFICE
Entity type:Organization
Organization Name:TRINITY BEHAVIORAL CARE DILLON OFFICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:T
Authorized Official - Last Name:OCONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-423-8292
Mailing Address - Street 1:204 MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:DILLON
Mailing Address - State:SC
Mailing Address - Zip Code:29536-3304
Mailing Address - Country:US
Mailing Address - Phone:843-774-6591
Mailing Address - Fax:843-774-1409
Practice Address - Street 1:204 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:DILLON
Practice Address - State:SC
Practice Address - Zip Code:29536-3304
Practice Address - Country:US
Practice Address - Phone:843-774-6591
Practice Address - Fax:843-774-1409
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRINITY BEHAVIORAL CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-11
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCOTP-004101YA0400X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAD28DNMedicaid