Healthcare Provider Details

I. General information

NPI: 1356487607
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: 01/30/2007
Last Update Date: 04/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 FAISON DR
COLUMBIA SC
29203-3210
US

IV. Provider business mailing address

220 FAISON DR
COLUMBIA SC
29203-3210
US

V. Phone/Fax

Practice location:
  • Phone: 803-935-7154
  • Fax: 803-935-5627
Mailing address:
  • Phone: 803-935-7154
  • Fax: 803-935-5627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number50001379
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number1379
License Number StateSC

VIII. Authorized Official

Name: MRS. CHRISTINE SHARP LATHAM
Title or Position: DIRECTOR OF PHARMACY
Credential: RPH
Phone: 803-935-7154