Healthcare Provider Details

I. General information

NPI: 1255703575
Provider Name (Legal Business Name): OPTIONS FOR SOCIAL CHANGE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2015
Last Update Date: 11/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2145 DORCHESTER RD
N CHARLESTON SC
29405-7763
US

IV. Provider business mailing address

2396 ERSKINE AVE
CHARLESTON SC
29414-7004
US

V. Phone/Fax

Practice location:
  • Phone: 843-343-4188
  • Fax:
Mailing address:
  • Phone: 843-343-4188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberSC 1449
License Number StateSC

VIII. Authorized Official

Name: MS. SHIRLEY FORD
Title or Position: EXECUTIVE DIRECTOR
Credential: MSW, LISW CP/AP
Phone: 843-343-4188