Healthcare Provider Details

I. General information

NPI: 1205065828
Provider Name (Legal Business Name): BERKELEY COMMUNITY MENTAL HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2009
Last Update Date: 07/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 STONEY LANDING RD
MONCKS CORNER SC
29461-3967
US

IV. Provider business mailing address

7863 LONG SHADOW LN
NORTH CHARLESTON SC
29406
US

V. Phone/Fax

Practice location:
  • Phone: 843-761-8282
  • Fax: 843-761-7308
Mailing address:
  • Phone: 843-761-8282
  • Fax: 843-761-7308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number3810
License Number StateSC

VIII. Authorized Official

Name: MRS. STANTRENETTA AKEYA HARROLD
Title or Position: ADVANCED PRACTICE REGISTERED NURSE
Credential: APRN
Phone: 843-761-8282