Healthcare Provider Details

I. General information

NPI: 1780745455
Provider Name (Legal Business Name): TRINITY BEHAVIORAL CARE - MARION OFFICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 07/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 N MAIN ST
MARION SC
29571-2010
US

IV. Provider business mailing address

PO BOX 1011
MARION SC
29571-1011
US

V. Phone/Fax

Practice location:
  • Phone: 843-423-8292
  • Fax:
Mailing address:
  • Phone: 843-423-8292
  • Fax: 843-423-8294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberOTP-004
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberOTP-004
License Number StateSC

VIII. Authorized Official

Name: MR. DONNY BROCK
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 843-423-8292