Healthcare Provider Details

I. General information

NPI: 1487665055
Provider Name (Legal Business Name): FAIRFIELD BEHAVIORAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 11/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

178 US HIGHWAY 321 BYPASS N.
WINNSBORO SC
29180
US

IV. Provider business mailing address

PO BOX 388
WINNSBORO SC
29180
US

V. Phone/Fax

Practice location:
  • Phone: 803-635-2335
  • Fax: 803-635-9695
Mailing address:
  • Phone: 803-635-2335
  • Fax: 803-635-9695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. VERNON LAMONT KENNEDY SR.
Title or Position: EXECUTIVE DIRECTOR
Credential: MA CPP
Phone: 803-635-2335