Healthcare Provider Details

I. General information

NPI: 1093179335
Provider Name (Legal Business Name): GREENVILLE COUNTY COMMISSION ON ALCOHOL AND DRUG ABUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2016
Last Update Date: 04/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 CLEVELAND ST
GREENVILLE SC
29607-2410
US

IV. Provider business mailing address

1400 CLEVELAND ST
GREENVILLE SC
29607-2410
US

V. Phone/Fax

Practice location:
  • Phone: 864-467-3780
  • Fax: 864-467-3779
Mailing address:
  • Phone: 864-467-3780
  • Fax: 864-467-3779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. REBECCA MADDOX
Title or Position: DEPUTY DIRECTOR
Credential:
Phone: 864-467-3742