Healthcare Provider Details

I. General information

NPI: 1972532075
Provider Name (Legal Business Name): LAURENS COUNTY COMMISSION ON ALCOHOL AND DRUG ABUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 04/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 HUMAN SERVICES ROAD
CLINTON SC
29325
US

IV. Provider business mailing address

219 HUMAN SERVICES ROAD
CLINTON SC
29325
US

V. Phone/Fax

Practice location:
  • Phone: 864-833-6500
  • Fax: 864-833-6905
Mailing address:
  • Phone: 864-833-6500
  • Fax: 864-833-6905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License NumberOTP-0035
License Number StateSC

VIII. Authorized Official

Name: MR. CHARLES STINSON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 864-833-6500