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General NPI Number Information
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NPI Number | 1134127475
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Entity Type | Organization
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Legal Business Name | PICKENS COUNTY COMMISSION ON ALCOHOL & DRUG ABUSE
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Dates
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Enumeration Date | 07/11/2005
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Last Update Date | 04/23/2024
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Provider Practice Location Address
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Address Line | 309 E MAIN ST
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City | PICKENS
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State | SC
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Zip | 29671-2319
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Country | US
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Telephone | 864-898-5800
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Fax | 864-898-5804
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Provider Business Mailing Address
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Address Line | 309 E MAIN ST
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City | PICKENS
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State | SC
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Zip | 29671-2319
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Country | US
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Telephone | 864-898-5800
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Fax | 864-898-5804
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Authorized Official
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Title or Position | DIRECTOR, FINANCIAL & ADMINISTRATIV
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Name | MRS. ANGELA A. ELLENBURG
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Credential |
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Telephone | 864-898-5800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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