Healthcare Provider Details

I. General information

NPI: 1316274228
Provider Name (Legal Business Name): LRC FOR SUBSTANCE ABUSE & BEHAVIORAL PROBS.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2009
Last Update Date: 11/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 BELLEVIEW ST.
COLUMBIA SC
29202
US

IV. Provider business mailing address

PO BOX 8724 1105 BELLEVIEW ST.
COLUMBIA SC
29202
US

V. Phone/Fax

Practice location:
  • Phone: 803-740-9298
  • Fax: 803-223-9420
Mailing address:
  • Phone: 803-740-9298
  • Fax: 803-223-9420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberOPT-0097
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberOPT-0097
License Number StateSC

VIII. Authorized Official

Name: MR. HENRY P. MCFADDEN
Title or Position: OWNER
Credential:
Phone: 803-740-9298