Healthcare Provider Details

I. General information

NPI: 1538153069
Provider Name (Legal Business Name): LEXINGTON RICHLAND ALCOHOL & DRUG ABUSE COUNCIL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 05/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2711 COLONIAL DRIVE
COLUMBIA SC
29203
US

IV. Provider business mailing address

PO BOX 50597
COLUMBIA SC
29250-0597
US

V. Phone/Fax

Practice location:
  • Phone: 803-726-9301
  • Fax: 803-726-9480
Mailing address:
  • Phone: 803-726-9301
  • Fax: 803-726-9480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateSC

VIII. Authorized Official

Name: MS. LINDA G AYCOCK
Title or Position: PRESIDENT & CEO
Credential: ESQ.
Phone: 803-726-9301