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General NPI Number Information
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NPI Number | 1053630863
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Entity Type | Organization
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Legal Business Name | MERRIMACK VALLEY TRAUMA SERVICES, INC.
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Dates
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Enumeration Date | 05/19/2010
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Last Update Date | 02/17/2023
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Provider Practice Location Address
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Address Line | 5900 CORE RD STE 401
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City | NORTH CHARLESTON
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State | SC
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Zip | 29406-6069
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Country | US
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Telephone | 843-400-3040
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Fax | 843-400-3040
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Provider Business Mailing Address
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Address Line | 5900 CORE RD STE 401
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City | NORTH CHARLESTON
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State | SC
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Zip | 29406-6069
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Country | US
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Telephone | 843-400-3040
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Fax | 843-400-3040
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DIANNE PATRICIA CORBIN
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Credential |
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Telephone | 843-400-3040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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