Healthcare Provider Details

I. General information

NPI: 1346594876
Provider Name (Legal Business Name): OFFICE OF THE GOVERNOR CONTINUUM OF CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2012
Last Update Date: 11/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 PENDLETON ST SUITE 341C
COLUMBIA SC
29201-3756
US

IV. Provider business mailing address

1205 PENDLETON ST SUITE 372
COLUMBIA SC
29201-3756
US

V. Phone/Fax

Practice location:
  • Phone: 803-737-1601
  • Fax: 803-737-1610
Mailing address:
  • Phone: 803-734-4500
  • Fax: 803-734-4538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. SHELLEY A MCGEORGE
Title or Position: DIRECTOR
Credential: PH.D.,MPA,LPC/S,LMFT
Phone: 803-734-4531