Healthcare Provider Details

I. General information

NPI: 1578045787
Provider Name (Legal Business Name): AIKEN CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2018
Last Update Date: 09/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 GREGG HWY NW
AIKEN SC
29801
US

IV. Provider business mailing address

1105 GREGG HWY NW
AIKEN SC
29801-6341
US

V. Phone/Fax

Practice location:
  • Phone: 803-649-1900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number6038
License Number StateSC

VIII. Authorized Official

Name: KEVIN CUNNINGHAM
Title or Position: DIRECTOR TREATMENT
Credential:
Phone: 803-649-1900