Healthcare Provider Details

I. General information

NPI: 1619995370
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: 07/18/2006
Last Update Date: 12/18/2023
Certification Date: 12/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 MALLARD ST
GREENVILLE SC
29601-4046
US

IV. Provider business mailing address

124 MALLARD ST
GREENVILLE SC
29601-4046
US

V. Phone/Fax

Practice location:
  • Phone: 864-241-1040
  • Fax: 864-241-1215
Mailing address:
  • Phone: 864-241-1040
  • Fax: 864-241-1215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER CROWE
Title or Position: BILLING
Credential:
Phone: 864-241-1040