Healthcare Provider Details

I. General information

NPI: 1851476337
Provider Name (Legal Business Name): DORCHESTER COMMISSION ON ALCOHOL AND DRUG ABUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 06/09/2023
Certification Date: 06/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 MIDLAND PKWY STE C
SUMMERVILLE SC
29485-7195
US

IV. Provider business mailing address

320 MIDLAND PKWY STE C
SUMMERVILLE SC
29485-7195
US

V. Phone/Fax

Practice location:
  • Phone: 843-871-4790
  • Fax: 844-965-9336
Mailing address:
  • Phone: 843-871-4790
  • Fax: 844-965-9336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberOTP-015
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberOTP-015
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateSC

VIII. Authorized Official

Name: SUE MALPHRUS
Title or Position: FINANCE DIRECTOR
Credential:
Phone: 843-871-4790