Healthcare Provider Details

I. General information

NPI: 1114922283
Provider Name (Legal Business Name): FLORENCE COUNTY COMMISSION ON ALCOHOL AND DRU
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 11/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 GREG AVENUE
FLORENCE SC
29501
US

IV. Provider business mailing address

PO BOX 6196
FLORENCE SC
29502
US

V. Phone/Fax

Practice location:
  • Phone: 843-665-3928
  • Fax: 843-667-1615
Mailing address:
  • Phone: 843-665-3929
  • Fax: 843-667-1615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. WILLIAM RUSSELL TERRELL JR.
Title or Position: DEPUTY CEO
Credential:
Phone: 843-665-9349