Healthcare Provider Details

I. General information

NPI: 1518979202
Provider Name (Legal Business Name): GEORGETOWN COUNTY ALCOHOL & DRUG ABUSE COMMISSION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 04/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1423 WINYAH ST
GEORGETOWN SC
29440-4730
US

IV. Provider business mailing address

PO BOX 515 1
GEORGETOWN SC
29442-0515
US

V. Phone/Fax

Practice location:
  • Phone: 843-546-6081
  • Fax: 843-527-1697
Mailing address:
  • Phone: 843-546-6081
  • Fax: 843-527-1697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. RALPHAEL MENSAH CARR
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 843-546-6081