Healthcare Provider Details

I. General information

NPI: 1679514079
Provider Name (Legal Business Name): NEW LIFE CENTER COMMISSION ON ALCOHOL & OTHER DRUG ABUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 09/28/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 GINN ALTMAN AVE SUITE C
HAMPTON SC
29924-3932
US

IV. Provider business mailing address

102 GINN ALTMAN AVE SUITE C
HAMPTON SC
29924-3932
US

V. Phone/Fax

Practice location:
  • Phone: 803-943-2800
  • Fax: 803-943-2267
Mailing address:
  • Phone: 803-943-2800
  • Fax: 803-943-2267

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 Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAMES HOLLEY
Title or Position: DEPUTY DIRECTOR
Credential: NCAC II, AADC, SAP
Phone: 803-943-2800