Healthcare Provider Details

I. General information

NPI: 1720014988
Provider Name (Legal Business Name): LANCASTER COUNTY COMMISSION ON ALCOHOL AND DRUG ABUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 06/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 S MAIN ST
LANCASTER SC
29720-2442
US

IV. Provider business mailing address

114 S MAIN ST
LANCASTER SC
29720-2442
US

V. Phone/Fax

Practice location:
  • Phone: 803-285-6911
  • Fax: 803-286-6697
Mailing address:
  • Phone: 803-285-6911
  • Fax: 803-286-6697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License NumberOTP-0032
License Number StateSC

VIII. Authorized Official

Name: MR. WALTER J. QUINN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 803-285-6911