MEDICARE: SOUTH CAROLINA DEPARTMENT OF JUVENILE JUSTICE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528108073
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH CAROLINA DEPARTMENT OF JUVENILE JUSTICE

Provider Business Mailing Address
First Line	:	PO BOX 21069
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29221-1069
Country	:	US
Telephone Number	:	803-896-4751
Fax Number	:	803-896-8473

Provider Business Practice Location Address
First Line	:	100 EXECUTIVE CENTER DR
Second Line	:	SANTEE BUILDING SUITE210
City	:	COLUMBIA
State	:	SC
Zip	:	29210-8407
Country	:	US
Telephone Number	:	803-896-4751
Fax Number	:	803-896-8473

Authorized Official
Title or Position	:	MEDICAID PROJECT ADMINISTRATOR
Name	:	MS. MIA L RICHARDSON
Credential	:
Telephone Number	:	803-896-4751

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	08/22/2020

Similar Medicare Providers

1750534509 — MRS. JENNIFER L CICCHILLO N.P.C.
Practice Location Address:

327 AIKEN HUNT CIR
COLUMBIA, SC
29223-8407

Practice Phone: 843-669-5162
Practice Fax: 843-667-4573

1740136860 — HOLLY MAY LPC LLC
Practice Location Address:

3139 SIDNEY RD
COLUMBIA, SC
29210-4430

Practice Phone: 803-470-5450
Practice Fax: 839-218-5828

1023965977 — SUSANNAH STURGES
Practice Location Address:

426 BUSH RIVER RD
COLUMBIA, SC
29210-7312

Practice Phone: 803-335-0718
Practice Fax:

1669329579 — CECILIA HUFF RBT
Practice Location Address:

426 BUSH RIVER RD
COLUMBIA, SC
29210-7312

Practice Phone: 803-335-0718
Practice Fax:

1124975750 — KENNEDI MINCEY
Practice Location Address:

1400 BROWNING RD STE 195
COLUMBIA, SC
29210-6941

Practice Phone: 803-999-3752
Practice Fax:

1952132235 — KYLEE TURNER NP
Practice Location Address:

136 STONEMARK LN STE 100C
COLUMBIA, SC
29210-3881

Practice Phone: 888-701-4661
Practice Fax: 888-239-2595

Directions to “SOUTH CAROLINA DEPARTMENT OF JUVENILE JUSTICE ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.