Healthcare Provider Details

I. General information

NPI: 1245255389
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: 07/12/2006
Last Update Date: 09/20/2019
Certification Date:
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: 803-231-2673
  • Fax:
Mailing address:
  • Phone: 803-898-8405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License NumberHTL503
License Number StateSC

VIII. Authorized Official

Name: VERSIE BELLAMY
Title or Position: DEPUTY DIRECTOR
Credential:
Phone: 803-935-5761