Healthcare Provider Details

I. General information

NPI: 1376595041
Provider Name (Legal Business Name): SOUTH CAROLINA DEPT OF MENTAL HEALTH ACCOUNTING OFFICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 HIGHWAY 252
ANDERSON SC
29621-5054
US

IV. Provider business mailing address

PO BOX 485
COLUMBIA SC
29202-0485
US

V. Phone/Fax

Practice location:
  • Phone: 803-898-8405
  • Fax: 803-898-8526
Mailing address:
  • Phone: 803-898-8405
  • Fax: 803-898-8526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State

VIII. Authorized Official

Name: TRACY L TURNER
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 803-898-4594