Healthcare Provider Details

I. General information

NPI: 1427392026
Provider Name (Legal Business Name): JUSTICE WORKS BEHAVIORAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2012
Last Update Date: 11/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 ELM ST SUITE 1
CONWAY SC
29526-5118
US

IV. Provider business mailing address

200 ELM ST SUITE 1
CONWAY SC
29526-5118
US

V. Phone/Fax

Practice location:
  • Phone: 843-359-7538
  • Fax: 843-488-1616
Mailing address:
  • Phone: 843-359-7538
  • Fax: 843-488-1616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberDO NOT HAVE ONE
License Number StateSC

VIII. Authorized Official

Name: MR. RICHARD CHARLES CHRISTIAN
Title or Position: EXECUTIVE DIRECTOR
Credential: M. ED.
Phone: 843-488-1615